Provider Demographics
NPI:1215165220
Name:HEWITT, JACK C (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:C
Last Name:HEWITT
Suffix:
Gender:M
Credentials:DC
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Other - First Name:
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Mailing Address - Street 1:10900 LOS ALAMITOS BLVD
Mailing Address - Street 2:#141
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2354
Mailing Address - Country:US
Mailing Address - Phone:562-508-5109
Mailing Address - Fax:855-419-4417
Practice Address - Street 1:10900 LOS ALAMITOS BLVD
Practice Address - Street 2:#141
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2354
Practice Address - Country:US
Practice Address - Phone:562-508-5109
Practice Address - Fax:855-419-4417
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC31004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31004OtherSTATE LICENSE #