Provider Demographics
NPI:1073500146
Name:CLEWIS, TOMMIE D (DC)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:D
Last Name:CLEWIS
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 1:921 E BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4338
Mailing Address - Country:US
Mailing Address - Phone:910-895-6042
Mailing Address - Fax:
Practice Address - Street 1:315 PAGE RD N STE 11
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-0087
Practice Address - Country:US
Practice Address - Phone:910-295-1215
Practice Address - Fax:910-295-1814
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH7000200OtherFIRST CAROLINA CARE
NC0846HOtherBLUE CROSS/BLUE SHIELD
NC890846HMedicaid
NCU20459Medicare UPIN
NC890846HMedicaid
NC2447096AMedicare PIN