Provider Demographics
NPI:1073644183
Name:LEWANDOWKI, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:LEWANDOWKI
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 1:1125 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4508
Mailing Address - Country:US
Mailing Address - Phone:215-396-7388
Mailing Address - Fax:
Practice Address - Street 1:1125 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4508
Practice Address - Country:US
Practice Address - Phone:215-396-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005610-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor