Provider Demographics
NPI:1912271115
Name:MARVIN JEROME LEWIS DC, INC.
Entity Type:Organization
Organization Name:MARVIN JEROME LEWIS DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-499-0123
Mailing Address - Street 1:3334 FM 1092 RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2287
Mailing Address - Country:US
Mailing Address - Phone:281-499-0123
Mailing Address - Fax:281-499-0240
Practice Address - Street 1:3334 FM 1092 RD
Practice Address - Street 2:SUITE 450
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2287
Practice Address - Country:US
Practice Address - Phone:281-499-0123
Practice Address - Fax:281-499-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601553Medicare PIN
TXT-14405Medicare UPIN