Provider Demographics
NPI:1114546827
Name:LEW, RICHARD K (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:LEW
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 1:42 CONSTITUTION CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4205
Mailing Address - Country:US
Mailing Address - Phone:732-303-9303
Mailing Address - Fax:
Practice Address - Street 1:42 CONSTITUTION CT
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4205
Practice Address - Country:US
Practice Address - Phone:732-303-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009640-1111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty