Provider Demographics
NPI:1134119340
Name:LEWIS, JOHN MICHAEL JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:LEWIS
Suffix:JR
Gender:
Credentials:DC
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0771
Mailing Address - Country:US
Mailing Address - Phone:405-819-7750
Mailing Address - Fax:360-298-7307
Practice Address - Street 1:123 N BEACH RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8205
Practice Address - Country:US
Practice Address - Phone:405-819-7750
Practice Address - Fax:360-298-7307
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2833111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46684OtherLABOR & INDUSTRIES
WA8933964OtherCRIME VICTIMS
WA8933964OtherCRIME VICTIMS
U41848Medicare UPIN