Healthcare Provider Details

I. General information

NPI: 1659651818
Provider Name (Legal Business Name): MICHAEL LEWEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 OCEAN FRONT WALK
SAN DIEGO CA
92109-8729
US

IV. Provider business mailing address

1050 ISLAND AVE UNIT 310
SAN DIEGO CA
92101-7260
US

V. Phone/Fax

Practice location:
  • Phone: 858-488-3597
  • Fax:
Mailing address:
  • Phone: 352-256-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: