Provider Demographics
NPI:1366832701
Name:LEWIS, NICKOLAS L (DC)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:L
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 1:420 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2036
Mailing Address - Country:US
Mailing Address - Phone:614-863-0097
Mailing Address - Fax:614-863-6949
Practice Address - Street 1:420 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2036
Practice Address - Country:US
Practice Address - Phone:614-863-0097
Practice Address - Fax:614-863-6949
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor