MEDICARE: FERNANDO O'LOUGHLIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC008761	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001416434	OTHER	PA	HIGHMARK BLUE SHIELD
2	2103005000	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1316002306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO O'LOUGHLIN D.C.

Provider Business Mailing Address
First Line	:	269 SPRINGDALE TER
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-3422
Country	:	US
Telephone Number	:	215-922-2242
Fax Number	:	215-922-2243

Provider Business Practice Location Address
First Line	:	826 CHRISTIAN ST SIDE ENTRANCE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3947
Country	:	US
Telephone Number	:	215-922-2242
Fax Number	:	215-922-2243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/02/2010

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