Provider Demographics
NPI:1164439832
Name:LEWIS, STEPHEN E (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
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 1:408 E LOOP 281
Mailing Address - Street 2:STE C
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7915
Mailing Address - Country:US
Mailing Address - Phone:903-663-1006
Mailing Address - Fax:903-663-1036
Practice Address - Street 1:408 E LOOP 281
Practice Address - Street 2:STE C
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7915
Practice Address - Country:US
Practice Address - Phone:903-663-1006
Practice Address - Fax:903-663-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2861 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601143OtherBLUE CROSS
TX601143Medicare PIN
TXT14404Medicare UPIN