Provider Demographics
NPI:1780642504
Name:LOOP, MATTHEW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:LOOP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3035 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1806
Mailing Address - Country:US
Mailing Address - Phone:770-985-5223
Mailing Address - Fax:770-985-5590
Practice Address - Street 1:3035 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 7
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1806
Practice Address - Country:US
Practice Address - Phone:770-985-5223
Practice Address - Fax:770-985-5590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA007718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor