Provider Demographics
NPI:1366446932
Name:LEWIS, KIMBERLY (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 RICHLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4760
Mailing Address - Country:US
Mailing Address - Phone:803-648-0172
Mailing Address - Fax:803-648-5062
Practice Address - Street 1:1028 RICHLAND AVE E
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4760
Practice Address - Country:US
Practice Address - Phone:803-648-0172
Practice Address - Fax:803-648-5062
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2563Medicaid
SCCH2563Medicaid