Provider Demographics
NPI:1184780231
Name:LEWIS, RAND H (DC)
Entity type:Individual
Prefix:
First Name:RAND
Middle Name:H
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 1:108 N LA COLINA RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-8802
Mailing Address - Country:US
Mailing Address - Phone:817-560-8100
Mailing Address - Fax:
Practice Address - Street 1:8808 CAMP BOWIE W
Practice Address - Street 2:SUITE 150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6028
Practice Address - Country:US
Practice Address - Phone:817-560-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5273111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYT91177Medicare UPIN