Healthcare Provider Details

I. General information

NPI: 1558278051
Provider Name (Legal Business Name): CHANNING LOFTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 LITHIA PINECREST RD STE 103
BRANDON FL
33511-6189
US

IV. Provider business mailing address

708 LITHIA PINECREST RD STE 103
BRANDON FL
33511-6189
US

V. Phone/Fax

Practice location:
  • Phone: 813-841-6504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number16060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: