Provider Demographics
NPI:1336210558
Name:HANDLOFF, BRUCE LEONARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEONARD
Last Name:HANDLOFF
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 1:4895 CAPITOLA RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3810
Mailing Address - Country:US
Mailing Address - Phone:831-476-7766
Mailing Address - Fax:831-476-7781
Practice Address - Street 1:4895 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3810
Practice Address - Country:US
Practice Address - Phone:831-476-7766
Practice Address - Fax:831-476-7781
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0171730Medicare ID - Type Unspecified
CADC0171730Medicare UPIN