MEDICARE: DOUGLAS C. LEWIS, ND, LLC

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	171100000X	Acupuncturist	AC60260599	WA
2	175F00000X	Naturopath	NT60216937	WA
3	175F00000X	Naturopath	999	WA
4	175F00000X	Naturopath	NT60260168	WA
5	175F00000X	Naturopath	0547	WA

General Provider Information

NPI Number	:	1902289309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS C. LEWIS, ND, LLC

Provider Business Mailing Address
First Line	:	11300 ROOSEVELT WAY NE STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6244
Country	:	US
Telephone Number	:	206-525-8078
Fax Number	:	206-525-1913

Provider Business Practice Location Address
First Line	:	11300 ROOSEVELT WAY NE STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6244
Country	:	US
Telephone Number	:	206-525-8078
Fax Number	:	206-525-1913

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS C. LEWIS
Credential	:	ND
Telephone Number	:	206-525-8078

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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