Provider Demographics
NPI:1932233418
Name:LEWIS, PHILLIP WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WAYNE
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 1:7606 FALLBROOK AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3610
Mailing Address - Country:US
Mailing Address - Phone:818-346-2225
Mailing Address - Fax:818-346-5836
Practice Address - Street 1:7606 FALLBROOK AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3610
Practice Address - Country:US
Practice Address - Phone:818-346-2225
Practice Address - Fax:818-346-5836
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU46630Medicare UPIN