Provider Demographics
NPI:1760584718
Name:LEWINTER, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:LEWINTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:LEWINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:515 CABRILLO PARK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5016
Mailing Address - Country:US
Mailing Address - Phone:949-300-1115
Mailing Address - Fax:877-618-1122
Practice Address - Street 1:515 CABRILLO PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5016
Practice Address - Country:US
Practice Address - Phone:949-300-1115
Practice Address - Fax:877-618-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 16467111N00000X, 111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC016467Medicare UPIN
CADC016467Medicare UPIN