Provider Demographics
NPI:1932130473
Name:LEWIS, MARC (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
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 1:6612 MISSION GORGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2346
Mailing Address - Country:US
Mailing Address - Phone:619-282-8181
Mailing Address - Fax:619-282-8205
Practice Address - Street 1:6612 MISSION GORGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2346
Practice Address - Country:US
Practice Address - Phone:619-282-8181
Practice Address - Fax:619-282-8205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor