Individual
LOREN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
16622 W. 159TH ST., SUITE 500, LOCKPORT, IL 60441-8015
(815) 838-7746
(815) 838-5090
Mailing address
16622 W. 159TH ST., SUITE 500, LOCKPORT, IL 60441-8015
(815) 838-7746
(815) 838-5090
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008320
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9932868
BLUE CROSS BLUE SHIELD
—
01
—
P00864465
PTAN
—
Enumeration date
05/02/2007
Last updated
11/17/2011
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