Healthcare Provider Details

I. General information

NPI: 1477402576
Provider Name (Legal Business Name): MATTHEW ALEXANDER SOEWITO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 CALLE ALCAZAR
WALNUT CA
91789-1615
US

IV. Provider business mailing address

16125 PROMONTORY RD
CHINO HILLS CA
91709-2362
US

V. Phone/Fax

Practice location:
  • Phone: 909-964-1662
  • Fax:
Mailing address:
  • Phone: 909-964-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: