Provider Demographics
NPI:1356463905
Name:MUSSON, LEWIS DALE (DC)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:DALE
Last Name:MUSSON
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 1:215 YOUNG LN
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1054
Mailing Address - Country:US
Mailing Address - Phone:859-498-6598
Mailing Address - Fax:859-497-9252
Practice Address - Street 1:215 YOUNG LN
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1054
Practice Address - Country:US
Practice Address - Phone:859-498-6598
Practice Address - Fax:859-497-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3351-R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6010101Medicare ID - Type Unspecified