Provider Demographics
NPI:1134278922
Name:LOWENBERG, PETER HUNT (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HUNT
Last Name:LOWENBERG
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 1:2220 MOUNTAIN BLVD
Mailing Address - Street 2:200A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2905
Mailing Address - Country:US
Mailing Address - Phone:510-531-1703
Mailing Address - Fax:510-531-0427
Practice Address - Street 1:2220 MOUNTAIN BLVD
Practice Address - Street 2:200A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2905
Practice Address - Country:US
Practice Address - Phone:510-531-1703
Practice Address - Fax:510-531-0427
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0223970Medicare ID - Type Unspecified