Provider Demographics
NPI:1841508637
Name:BLEVINS, LEWIS DONALD II (DC)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:DONALD
Last Name:BLEVINS
Suffix:II
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 1:525 TYLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3305
Mailing Address - Country:US
Mailing Address - Phone:313-492-9136
Mailing Address - Fax:
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-524-2445
Practice Address - Fax:630-443-3209
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor