Provider Demographics
NPI:1033230958
Name:LEWIS, KASEY K (DC)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:K
Last Name:LEWIS
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 1:16017 IDAHO CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5010
Mailing Address - Country:US
Mailing Address - Phone:208-461-4430
Mailing Address - Fax:
Practice Address - Street 1:16017 IDAHO CENTER BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5010
Practice Address - Country:US
Practice Address - Phone:208-461-4460
Practice Address - Fax:208-461-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC7226Medicare UPIN
ID000010022469Medicare UPIN