Provider Demographics
NPI:1487730701
Name:LOOSE, JENNIFER (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOOSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:330 W COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2450
Mailing Address - Country:US
Mailing Address - Phone:307-237-2050
Mailing Address - Fax:307-234-3056
Practice Address - Street 1:330 W COLLINS DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2450
Practice Address - Country:US
Practice Address - Phone:307-237-2050
Practice Address - Fax:307-234-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor