Provider Demographics
NPI:1831122779
Name:LEWIS, RYAN K (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:K
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 1:604 EDWARDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1336
Mailing Address - Country:US
Mailing Address - Phone:618-667-8100
Mailing Address - Fax:618-667-8104
Practice Address - Street 1:604 EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1336
Practice Address - Country:US
Practice Address - Phone:618-667-8100
Practice Address - Fax:618-667-8104
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38009982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL567876OtherHEALTHLINK
IL6032078OtherBLUE CROSS BLUE SHIELD
IL038009982Medicaid
MO183345OtherBLUE CROSS BLUE SHIELD
ILP00107987OtherRAILROAD MEDICARE
IL567876OtherHEALTHLINK
ILP00107987OtherRAILROAD MEDICARE