Provider Demographics
NPI:1811622061
Name:LEW, GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LEW
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 1:2350 MONUMENT BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3954
Mailing Address - Country:US
Mailing Address - Phone:925-676-8200
Mailing Address - Fax:
Practice Address - Street 1:2350 MONUMENT BLVD STE C
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3954
Practice Address - Country:US
Practice Address - Phone:925-676-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34958OtherCHIROPRACTIC