Provider Demographics
NPI:1578629861
Name:HINSON, LEWIS R (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:R
Last Name:HINSON
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11596
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-1596
Mailing Address - Country:US
Mailing Address - Phone:803-783-0644
Mailing Address - Fax:803-783-0685
Practice Address - Street 1:6420 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1632
Practice Address - Country:US
Practice Address - Phone:803-783-0644
Practice Address - Fax:803-783-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1581111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician