Provider Demographics
NPI:1457540643
Name:LOOMIS, LANCE JARROD (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:JARROD
Last Name:LOOMIS
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 1:9403 HARFORD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3123
Mailing Address - Country:US
Mailing Address - Phone:410-882-0720
Mailing Address - Fax:410-882-6767
Practice Address - Street 1:9403 HARFORD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3123
Practice Address - Country:US
Practice Address - Phone:410-882-0720
Practice Address - Fax:410-882-6767
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor