Provider Demographics
NPI:1194563775
Name:LOEWENSTEIN, JORDAN KEITH (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:KEITH
Last Name:LOEWENSTEIN
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 1:6629 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6019
Mailing Address - Country:US
Mailing Address - Phone:925-858-5507
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B212
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1708
Practice Address - Country:US
Practice Address - Phone:858-558-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor