Provider Demographics
NPI:1053525105
Name:LOEB, STEWART SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:SAMUEL
Last Name:LOEB
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 1:7400 RIVERDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-577-6556
Mailing Address - Fax:301-577-6558
Practice Address - Street 1:7400 RIVERDALE ROAD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-577-6556
Practice Address - Fax:301-577-6558
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1496PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
S8120001OtherBCBS
930996OtherAETNA
M471OtherBCBS
M471OtherBCBS