Provider Demographics
NPI:1699811240
Name:LEWIS, WAYNE MURRAY (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MURRAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1164 WEST COUNTY ROAD 125 SOUTH
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-8478
Mailing Address - Country:US
Mailing Address - Phone:765-653-3454
Mailing Address - Fax:765-653-0871
Practice Address - Street 1:1164 WEST COUNTY ROAD 125 SOUTH
Practice Address - Street 2:WEST WALNUT STREET ROAD
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-8478
Practice Address - Country:US
Practice Address - Phone:765-653-3454
Practice Address - Fax:765-653-0871
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000474A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34973Medicare UPIN
IN680670Medicare ID - Type Unspecified