Provider Demographics
NPI:1639475874
Name:LOZANO, PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:LOZANO
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 1:1640 2ND ST
Mailing Address - Street 2:UNIT 208
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2969
Mailing Address - Country:US
Mailing Address - Phone:951-751-9177
Mailing Address - Fax:
Practice Address - Street 1:1640 2ND ST
Practice Address - Street 2:UNIT 208
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2969
Practice Address - Country:US
Practice Address - Phone:951-751-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor