Provider Demographics
NPI:1083733539
Name:LOUGHLIN, KEVIN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:LOUGHLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 COMMERCIAL ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1067
Mailing Address - Country:US
Mailing Address - Phone:617-742-5797
Mailing Address - Fax:617-742-8250
Practice Address - Street 1:414 COMMERCIAL ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1067
Practice Address - Country:US
Practice Address - Phone:617-742-5797
Practice Address - Fax:617-742-8250
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA716209OtherTUFTS
MAY35614OtherBLUE CROSS & BLUE SHIELD
MA716209OtherTUFTS