Healthcare Provider Details

I. General information

NPI: 1932384898
Provider Name (Legal Business Name): LEWIS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16017 IDAHO CENTER BLVD
NAMPA ID
83687-5010
US

IV. Provider business mailing address

16017 IDAHO CENTER BLVD
NAMPA ID
83687-5010
US

V. Phone/Fax

Practice location:
  • Phone: 208-461-4430
  • Fax: 208-461-4326
Mailing address:
  • Phone: 208-461-4430
  • Fax: 208-461-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA722
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCHIA722
License Number StateID

VIII. Authorized Official

Name: DR. KASEY K LEWIS
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 208-461-4430