Provider Demographics
NPI:1376854851
Name:LEW, ANGELA L (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:LEW
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 1:700 WOLSKE BAY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1659
Mailing Address - Country:US
Mailing Address - Phone:715-231-2233
Mailing Address - Fax:715-231-2236
Practice Address - Street 1:700 WOLSKE BAY RD
Practice Address - Street 2:STE 150
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1659
Practice Address - Country:US
Practice Address - Phone:715-231-2233
Practice Address - Fax:715-231-2236
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4638-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor