Provider Demographics
NPI:1235123951
Name:SQUIRES, LEWIS G (DC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:G
Last Name:SQUIRES
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:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454-0296
Mailing Address - Country:US
Mailing Address - Phone:231-757-3356
Mailing Address - Fax:231-757-4640
Practice Address - Street 1:414 W US HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454-9274
Practice Address - Country:US
Practice Address - Phone:231-757-3356
Practice Address - Fax:231-757-4640
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS002869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1661077Medicaid
MI1661077Medicaid
0E35008Medicare ID - Type Unspecified