Provider Demographics
NPI:1760583264
Name:LEWIS, STEVEN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
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 1:1552 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3716
Mailing Address - Country:US
Mailing Address - Phone:360-577-8442
Mailing Address - Fax:
Practice Address - Street 1:1552 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3716
Practice Address - Country:US
Practice Address - Phone:360-577-8442
Practice Address - Fax:360-423-8153
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor