Healthcare Provider Details

I. General information

NPI: 1578629861
Provider Name (Legal Business Name): LEWIS R HINSON D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 GARNERS FERRY RD
COLUMBIA SC
29209-1632
US

IV. Provider business mailing address

PO BOX 11596
COLUMBIA SC
29211-1596
US

V. Phone/Fax

Practice location:
  • Phone: 803-783-0644
  • Fax: 803-783-0685
Mailing address:
  • Phone: 803-783-0644
  • Fax: 803-783-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1581
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: