Provider Demographics
NPI:1386246742
Name:LOFTHOUSE, DUSTIN STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:STEVEN
Last Name:LOFTHOUSE
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 1:1181 MANCHESTER WAY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4713
Mailing Address - Country:US
Mailing Address - Phone:404-824-1950
Mailing Address - Fax:
Practice Address - Street 1:608 MORELAND AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1425
Practice Address - Country:US
Practice Address - Phone:404-687-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor