Healthcare Provider Details

I. General information

NPI: 1760584718
Provider Name (Legal Business Name): BRUCE LEWINTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRUCE LEWINTER DC

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CABRILLO PARK DR STE 100
SANTA ANA CA
92701-5016
US

IV. Provider business mailing address

515 CABRILLO PARK DR STE 100
SANTA ANA CA
92701-5016
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-1115
  • Fax: 877-618-1122
Mailing address:
  • Phone: 949-300-1115
  • Fax: 877-618-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 16467
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC 16467
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC 16467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: