Provider Demographics
NPI:1649399395
Name:LEWIS, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
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 1:209 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9687
Mailing Address - Country:US
Mailing Address - Phone:317-984-3578
Mailing Address - Fax:317-984-3410
Practice Address - Street 1:209 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9687
Practice Address - Country:US
Practice Address - Phone:317-984-3578
Practice Address - Fax:317-984-3410
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200072370AMedicaid
IN810980AMedicare ID - Type Unspecified
INM400061907Medicare PIN
INU55452Medicare UPIN
IN200072370AMedicaid