Provider Demographics
NPI:1336411016
Name:LOSCH FAMILY CHIROPRACTIC CENTER, PS
Entity Type:Organization
Organization Name:LOSCH FAMILY CHIROPRACTIC CENTER, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-770-7263
Mailing Address - Street 1:16714 MERIDIAN E STE 6
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6143
Mailing Address - Country:US
Mailing Address - Phone:253-770-7263
Mailing Address - Fax:253-445-2456
Practice Address - Street 1:16714 MERIDIAN E STE 6
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6143
Practice Address - Country:US
Practice Address - Phone:253-770-7263
Practice Address - Fax:253-445-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610564519261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU20482Medicare UPIN