Provider Demographics
NPI:1003091034
Name:LEWIS FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LEWIS FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-422-1551
Mailing Address - Street 1:9304 STATE ROUTE 43
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5326
Mailing Address - Country:US
Mailing Address - Phone:330-422-1551
Mailing Address - Fax:
Practice Address - Street 1:9304 STATE ROUTE 43
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5326
Practice Address - Country:US
Practice Address - Phone:330-422-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000213133OtherANTHEM BLUE CROSS BLUE SH
OHP00093170OtherMEDICARE RAILROAD
OH=========-00OtherBUR. OF WORK. COMP.
OH000000213133OtherANTHEM BLUE CROSS BLUE SH