Provider Demographics
NPI:1528004025
Name:LEWIS-OVERTON, DOREEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:LEWIS-OVERTON
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 1:1006 CENTRAL PKWY S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5021
Mailing Address - Country:US
Mailing Address - Phone:210-490-9169
Mailing Address - Fax:210-545-7740
Practice Address - Street 1:1006 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-490-9169
Practice Address - Fax:210-545-7740
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4193111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14399Medicare UPIN
TX601934Medicare PIN