Provider Demographics
NPI:1427376177
Name:LEWIS FAMILY CHIROPRACTIC AND WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:LEWIS FAMILY CHIROPRACTIC AND WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-876-8885
Mailing Address - Street 1:403 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6107
Mailing Address - Country:US
Mailing Address - Phone:410-876-8885
Mailing Address - Fax:410-876-5961
Practice Address - Street 1:403 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6107
Practice Address - Country:US
Practice Address - Phone:410-876-8885
Practice Address - Fax:410-876-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01471111N00000X
MDS03604111N00000X
MD01528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty