Provider Demographics
NPI:1972678878
Name:THEODORE B. LOOS, DC, PC
Entity Type:Organization
Organization Name:THEODORE B. LOOS, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-348-8138
Mailing Address - Street 1:655 GEORGES LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1934
Mailing Address - Country:US
Mailing Address - Phone:610-348-8138
Mailing Address - Fax:610-643-6139
Practice Address - Street 1:899 PENN ST
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3849
Practice Address - Country:US
Practice Address - Phone:610-348-8138
Practice Address - Fax:610-643-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty