Provider Demographics
NPI:1083756621
Name:LEWIS, WARD HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:WARD
Middle Name:HENRY
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 1:591 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1217
Mailing Address - Country:US
Mailing Address - Phone:651-464-2133
Mailing Address - Fax:651-982-6903
Practice Address - Street 1:591 N SHORE DR
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1217
Practice Address - Country:US
Practice Address - Phone:651-464-2133
Practice Address - Fax:651-982-6903
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39708Medicare UPIN
MNC00586Medicare ID - Type Unspecified