Provider Demographics
NPI:1811917438
Name:LEWIS, KEITH EDWARD (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:EDWARD
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 1:2460 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3868
Mailing Address - Country:US
Mailing Address - Phone:614-485-9006
Mailing Address - Fax:866-438-7821
Practice Address - Street 1:2460 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3868
Practice Address - Country:US
Practice Address - Phone:614-485-9006
Practice Address - Fax:866-438-7831
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0570841Medicaid
OHT48017Medicare UPIN
OH0570841Medicaid