MEDICARE: DR. MARVIN JEROME 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	4012	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601553	OTHER	TX	BLUE CROSS & BLUE SHIELD
2	0004010630	OTHER	TX	AETNA
3	697141	OTHER	TX	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1427066505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN JEROME LEWIS D.C.

Provider Business Mailing Address
First Line	:	3334 FM 1092 RD STE 450
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2298
Country	:	US
Telephone Number	:	281-499-0123
Fax Number	:	281-499-0240

Provider Business Practice Location Address
First Line	:	3334 FM 1092 RD STE 450
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2298
Country	:	US
Telephone Number	:	281-499-0123
Fax Number	:	281-499-0240

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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