Provider Demographics
NPI:1841290954
Name:LOUCKS, JOHN ALAN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:LOUCKS
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 1:613 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1101
Mailing Address - Country:US
Mailing Address - Phone:309-944-4599
Mailing Address - Fax:
Practice Address - Street 1:613 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1101
Practice Address - Country:US
Practice Address - Phone:309-944-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-3525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1982020OtherBLUE SHIELD
IL1982020OtherBLUE SHIELD
T39180Medicare UPIN