Healthcare Provider Details

I. General information

NPI: 1609095496
Provider Name (Legal Business Name): LARRY JAY LOEWEN JR. D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 COMMERCIAL AVE SUITE 3
CRYSTAL FALLS MI
49920-1085
US

IV. Provider business mailing address

1374 COMMERCIAL AVE SUITE 3
CRYSTAL FALLS MI
49920-1085
US

V. Phone/Fax

Practice location:
  • Phone: 906-875-3215
  • Fax: 906-874-3215
Mailing address:
  • Phone: 906-875-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008438
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301008438
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301008438
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number2301008438
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2301008438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: