Provider Demographics
NPI:1366470668
Name:LEWIS, TERESA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:209 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9687
Mailing Address - Country:US
Mailing Address - Phone:317-984-3578
Mailing Address - Fax:317-984-3410
Practice Address - Street 1:209 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9687
Practice Address - Country:US
Practice Address - Phone:317-984-3578
Practice Address - Fax:317-984-3410
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200161260-AMedicaid
IN200161260-AMedicaid
IN213570-AMedicare PIN