Provider Demographics
NPI:1942213293
Name:MOCK, LEWIS EMMETT III (DC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:EMMETT
Last Name:MOCK
Suffix:III
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 1:2020 N CORONA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7009
Mailing Address - Country:US
Mailing Address - Phone:719-632-4724
Mailing Address - Fax:
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-473-7464
Practice Address - Fax:719-473-2861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor