Provider Demographics
NPI:1659438687
Name:LONEY, JEREMY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PAUL
Last Name:LONEY
Suffix:
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 1:1408 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-1302
Mailing Address - Country:US
Mailing Address - Phone:765-329-5044
Mailing Address - Fax:765-329-5047
Practice Address - Street 1:1408 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-1302
Practice Address - Country:US
Practice Address - Phone:765-329-5044
Practice Address - Fax:765-329-5047
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002626A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201224750Medicaid
IN260720002Medicare PIN