Provider Demographics
NPI:1659445039
Name:BRUCE, SHARON (DC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3199 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1785
Mailing Address - Country:US
Mailing Address - Phone:562-961-7660
Mailing Address - Fax:562-961-8535
Practice Address - Street 1:3199 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1785
Practice Address - Country:US
Practice Address - Phone:562-961-7660
Practice Address - Fax:562-961-8535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26846111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26846Medicare ID - Type Unspecified