MEDICARE: DR. JEFFREY E. LEWIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1645	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y424	OTHER	AR	BCBS PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396743845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY E. LEWIS D.C.

Provider Business Mailing Address
First Line	:	212 SOUTH WASHINGTON
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-2669
Country	:	US
Telephone Number	:	870-235-3100
Fax Number	:	870-235-3101

Provider Business Practice Location Address
First Line	:	212 SOUTH WASHINGTON
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-2669
Country	:	US
Telephone Number	:	870-235-3100
Fax Number	:	870-235-3101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	09/25/2008

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