Provider Demographics
NPI:1790843647
Name:LEWIS, JOSEPH M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
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 1:985 W OKLAHOMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53125-4749
Mailing Address - Country:US
Mailing Address - Phone:414-481-1021
Mailing Address - Fax:414-481-3044
Practice Address - Street 1:985 W OKLAHOMA AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53125-4749
Practice Address - Country:US
Practice Address - Phone:414-481-1021
Practice Address - Fax:414-481-3044
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIPIN#35686OtherMEDICARE
WIPIN#70560OtherMEDICARE
WIPIN#35686OtherMEDICARE
WI0003Medicare ID - Type UnspecifiedSEQ#