Provider Demographics
NPI:1366543027
Name:LOUCKS, JAMES MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:LOUCKS
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 1:1139 BUSH ST
Mailing Address - Street 2:STE C
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2448
Mailing Address - Country:US
Mailing Address - Phone:650-593-1103
Mailing Address - Fax:650-593-1103
Practice Address - Street 1:1139 BUSH ST
Practice Address - Street 2:STE C
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2448
Practice Address - Country:US
Practice Address - Phone:650-593-1103
Practice Address - Fax:650-593-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC241650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60203Medicare UPIN
CADCO241650Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CADC0241650Medicare PIN