Provider Demographics
NPI:1669895819
Name:MARK A. LOESSER D.C., INC
Entity type:Organization
Organization Name:MARK A. LOESSER D.C., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBERA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-424-4058
Mailing Address - Street 1:1000 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6204
Mailing Address - Country:US
Mailing Address - Phone:419-424-4058
Mailing Address - Fax:419-424-1191
Practice Address - Street 1:1000 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6204
Practice Address - Country:US
Practice Address - Phone:419-424-4058
Practice Address - Fax:419-424-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500501OtherMEDICARE PTAN
OH886OtherBUREAU OF WORKER'S COMPENSATION
OH0478095Medicaid
OH350022377OtherMEDICARE RAILROAD