Provider Demographics
NPI:1396743845
Name:LEWIS, JEFFREY E (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
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 1:212 SOUTH WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2669
Mailing Address - Country:US
Mailing Address - Phone:870-235-3100
Mailing Address - Fax:870-235-3101
Practice Address - Street 1:212 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2669
Practice Address - Country:US
Practice Address - Phone:870-235-3100
Practice Address - Fax:870-235-3101
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y424OtherBCBS PIN
AR158872718Medicaid
AR5Y424Medicare ID - Type Unspecified
ARV05770Medicare UPIN