Provider Demographics
NPI:1790810190
Name:LUTES, BRUCE A (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:LUTES
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:PO BOX 1693
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-8193
Mailing Address - Country:US
Mailing Address - Phone:209-538-4500
Mailing Address - Fax:209-538-1419
Practice Address - Street 1:1768 MITCHELL RD
Practice Address - Street 2:STE303
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-8193
Practice Address - Country:US
Practice Address - Phone:209-538-4500
Practice Address - Fax:209-538-1419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0200580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor