Provider Demographics
NPI:1679990519
Name:LEWIS, CEDRIC M (DC)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
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 1:880 BEHRMAN HWY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4546
Mailing Address - Country:US
Mailing Address - Phone:504-394-0001
Mailing Address - Fax:504-304-6444
Practice Address - Street 1:880 BEHRMAN HWY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4546
Practice Address - Country:US
Practice Address - Phone:504-394-0001
Practice Address - Fax:504-304-6444
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor