Provider Demographics
NPI:1841370418
Name:LOOMIS CHIROPRACTIC AND ACUPUNCTURE CENTER, INC.
Entity type:Organization
Organization Name:LOOMIS CHIROPRACTIC AND ACUPUNCTURE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-579-8891
Mailing Address - Street 1:PO BOX 4069
Mailing Address - Street 2:10195-1 BEACH DRIVE, SW
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-9820
Mailing Address - Country:US
Mailing Address - Phone:910-579-8891
Mailing Address - Fax:910-579-0649
Practice Address - Street 1:10195 BEACH DR SW # 1
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2701
Practice Address - Country:US
Practice Address - Phone:910-579-8891
Practice Address - Fax:910-579-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08593OtherBLUE CROSS BLUE SHIELD
NC7908593Medicaid
NCT64545Medicare UPIN
NC08593OtherBLUE CROSS BLUE SHIELD