Provider Demographics
NPI:1609095496
Name:LOEWEN, LARRY JAY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAY
Last Name:LOEWEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 COMMERCIAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920-1085
Mailing Address - Country:US
Mailing Address - Phone:906-875-3215
Mailing Address - Fax:
Practice Address - Street 1:1374 COMMERCIAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-1085
Practice Address - Country:US
Practice Address - Phone:906-875-3215
Practice Address - Fax:906-874-3215
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008438111N00000X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D75037OtherBLUE CROSS BLUE SHIELD