Provider Demographics
NPI:1700898541
Name:LEWIS CHIROPRACTIC PA
Entity type:Organization
Organization Name:LEWIS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-476-1686
Mailing Address - Street 1:7219 FAIRMONT PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4611
Mailing Address - Country:US
Mailing Address - Phone:281-476-1686
Mailing Address - Fax:281-402-1032
Practice Address - Street 1:7219 FAIRMONT PKWY STE 180
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4611
Practice Address - Country:US
Practice Address - Phone:281-476-1686
Practice Address - Fax:281-402-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080NCOtherBCBS
TX0080NCOtherBCBS