Provider Demographics
NPI:1164621512
Name:LEWIS ADAMSON BLACK P.C.
Entity Type:Organization
Organization Name:LEWIS ADAMSON BLACK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:ADAMSON
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-564-9515
Mailing Address - Street 1:112 W MONTEZUMA AVE
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2759
Mailing Address - Country:US
Mailing Address - Phone:970-564-9515
Mailing Address - Fax:970-564-9164
Practice Address - Street 1:112 W MONTEZUMA AVE
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2759
Practice Address - Country:US
Practice Address - Phone:970-564-9515
Practice Address - Fax:970-564-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO498328Medicare PIN