Provider Demographics
NPI:1215914387
Name:LOFTUS, DANIEL SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N63W23524 SILVER SPRING DR
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3833
Mailing Address - Country:US
Mailing Address - Phone:262-246-8811
Mailing Address - Fax:
Practice Address - Street 1:N63W23524 SILVER SPRING DR
Practice Address - Street 2:SUITE #4
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3833
Practice Address - Country:US
Practice Address - Phone:262-246-8811
Practice Address - Fax:262-246-8894
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391777078018OtherBLUE CROSS BLUE SHIELD
WI000075129Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WI391777078018OtherBLUE CROSS BLUE SHIELD
WI350016014Medicare ID - Type UnspecifiedRR MEDICARE