Provider Demographics
NPI:1538792718
Name:LODWIG, MICHAEL J (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LODWIG
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 1:22179 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-7107
Mailing Address - Country:US
Mailing Address - Phone:510-880-9557
Mailing Address - Fax:510-582-0937
Practice Address - Street 1:22179 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7107
Practice Address - Country:US
Practice Address - Phone:510-880-9557
Practice Address - Fax:510-582-0937
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor