Provider Demographics
NPI:1043377658
Name:LEWIS, DAVID JEREMY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEREMY
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 1:1941 OFARRELL ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1374
Mailing Address - Country:US
Mailing Address - Phone:650-212-3111
Mailing Address - Fax:
Practice Address - Street 1:1941 OFARRELL ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1374
Practice Address - Country:US
Practice Address - Phone:650-212-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor