Provider Demographics
NPI:1265678254
Name:LEWIS, RAYMOND PONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PONALD
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 1:2718 WADE HAMPTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1165
Mailing Address - Country:US
Mailing Address - Phone:864-268-9040
Mailing Address - Fax:
Practice Address - Street 1:2718 WADE HAMPTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1165
Practice Address - Country:US
Practice Address - Phone:864-268-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor