Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 004109 | MO |
NPI | 1003864463 |
---|---|
Provider Name | Frederick Franklin Loeb |
First Address | Kansas City, MO 64131-4031 |
Second Address | Kansas City, MO 64131-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07306017 | BLUE CROSS BLUE SHIELD (01) | MO |