Healthcare Provider Details

I. General information

NPI: 1184780231
Provider Name (Legal Business Name): RAND H. LEWIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 CAMP BOWIE W SUITE 150
FORT WORTH TX
76116-6028
US

IV. Provider business mailing address

108 N LA COLINA RD
WEATHERFORD TX
76085-8802
US

V. Phone/Fax

Practice location:
  • Phone: 817-560-8100
  • Fax:
Mailing address:
  • Phone: 817-560-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: