Provider Demographics
NPI:1255531828
Name:LEWIS, MARK CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
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 1:6156 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9707
Mailing Address - Country:US
Mailing Address - Phone:941-755-9355
Mailing Address - Fax:941-755-9313
Practice Address - Street 1:6156 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9707
Practice Address - Country:US
Practice Address - Phone:941-755-9355
Practice Address - Fax:941-755-9313
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor