Provider Demographics
NPI:1679930333
Name:LEWIS, MADILYN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:MADILYN
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:MARINE
Mailing Address - State:IL
Mailing Address - Zip Code:62061-1302
Mailing Address - Country:US
Mailing Address - Phone:618-887-2017
Mailing Address - Fax:
Practice Address - Street 1:407 N DUNCAN ST
Practice Address - Street 2:
Practice Address - City:MARINE
Practice Address - State:IL
Practice Address - Zip Code:62061-1310
Practice Address - Country:US
Practice Address - Phone:618-887-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor