Provider Demographics
NPI:1609092089
Name:LEWIS, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
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 1:1731 E 20TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0974
Mailing Address - Country:US
Mailing Address - Phone:417-782-2504
Mailing Address - Fax:417-782-4726
Practice Address - Street 1:1731 E 20TH ST
Practice Address - Street 2:STE C
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0974
Practice Address - Country:US
Practice Address - Phone:417-782-2504
Practice Address - Fax:417-782-4726
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO006161OtherSTATE LICENSE
MO006161OtherSTATE LICENSE