Provider Demographics
NPI:1558570481
Name:LEWIS, DUSTIN LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEON
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 1:3214 50TH STREET CT NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8589
Mailing Address - Country:US
Mailing Address - Phone:253-858-9783
Mailing Address - Fax:
Practice Address - Street 1:355 LINHART AVE. NE
Practice Address - Street 2:
Practice Address - City:NAPAVINE
Practice Address - State:WA
Practice Address - Zip Code:98570-0329
Practice Address - Country:US
Practice Address - Phone:360-266-8800
Practice Address - Fax:360-266-8700
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869330OtherMEDICARE PTAN