Provider Demographics
NPI:1639185481
Name:JEFFERY E. LEWIS, D.C.
Entity Type:Organization
Organization Name:JEFFERY E. LEWIS, D.C.
Other - Org Name:FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-235-3100
Mailing Address - Street 1:212 SOUTH WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2654
Mailing Address - Country:US
Mailing Address - Phone:870-235-3100
Mailing Address - Fax:870-235-3101
Practice Address - Street 1:212 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2654
Practice Address - Country:US
Practice Address - Phone:870-235-3100
Practice Address - Fax:870-235-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F325OtherBCBS PIN
AR5Y424F325Medicare PIN