Provider Demographics
NPI:1851461107
Name:LEWIS, WILLIAM ERIC
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6419
Mailing Address - Country:US
Mailing Address - Phone:432-685-1442
Mailing Address - Fax:432-685-1445
Practice Address - Street 1:2101 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6419
Practice Address - Country:US
Practice Address - Phone:432-685-1442
Practice Address - Fax:432-685-1445
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002112301Medicaid
TXU80964Medicare UPIN
TX002112301Medicaid