Healthcare Provider Details

I. General information

NPI: 1134119340
Provider Name (Legal Business Name): JOHN MICHAEL LEWIS JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE LEWIS DC

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N BEACH RD
EASTSOUND WA
98245-8205
US

IV. Provider business mailing address

PO BOX 771
EASTSOUND WA
98245-0771
US

V. Phone/Fax

Practice location:
  • Phone: 405-819-7750
  • Fax: 360-298-7307
Mailing address:
  • Phone: 405-819-7750
  • Fax: 360-298-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: