MEDICARE: LOOMIS CHIROPRACTIC AND ACUPUNCTURE CENTER, INC.

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	936	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08593	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841370418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOOMIS CHIROPRACTIC AND ACUPUNCTURE CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 4069
Second Line	:	10195-1 BEACH DRIVE, SW
City	:	CALABASH
State	:	NC
Zip	:	28467-9820
Country	:	US
Telephone Number	:	910-579-8891
Fax Number	:	910-579-0649

Provider Business Practice Location Address
First Line	:	10195 BEACH DR SW # 1
Second Line	:
City	:	CALABASH
State	:	NC
Zip	:	28467-2701
Country	:	US
Telephone Number	:	910-579-8891
Fax Number	:	910-579-0649

Authorized Official
Title or Position	:	CO-OWNER/CHIROPRACTIC PHYSICIAN
Name	:	DR. CHARLES F LOOMIS
Credential	:	D.C.
Telephone Number	:	910-579-8891

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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