Healthcare Provider Details

I. General information

NPI: 1679249536
Provider Name (Legal Business Name): MILES M LOOSEMORE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10068 W LOOMIS RD
FRANKLIN WI
53132-8109
US

IV. Provider business mailing address

10068 W LOOMIS RD
FRANKLIN WI
53132-8109
US

V. Phone/Fax

Practice location:
  • Phone: 414-525-9895
  • Fax: 262-257-9966
Mailing address:
  • Phone: 414-525-9895
  • Fax: 262-257-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5673-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: