Provider Demographics
NPI:1598944852
Name:LEWIS CHIROPRACTIC
Entity Type:Organization
Organization Name:LEWIS CHIROPRACTIC
Other - Org Name:LEWIS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-847-5115
Mailing Address - Street 1:8009 CREEDMOOR RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4393
Mailing Address - Country:US
Mailing Address - Phone:919-847-5115
Mailing Address - Fax:919-870-0996
Practice Address - Street 1:8009 CREEDMOOR RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4393
Practice Address - Country:US
Practice Address - Phone:919-847-5115
Practice Address - Fax:919-870-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2452588AMedicare PIN
NC2452588Medicare PIN