Provider Demographics
NPI:1215386040
Name:DANIEL J LEWIS D.C. LLC
Entity Type:Organization
Organization Name:DANIEL J LEWIS D.C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-507-9380
Mailing Address - Street 1:1234 NE 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1977
Mailing Address - Country:US
Mailing Address - Phone:549-507-9380
Mailing Address - Fax:954-522-5543
Practice Address - Street 1:1234 NE 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1977
Practice Address - Country:US
Practice Address - Phone:954-507-9380
Practice Address - Fax:954-522-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty