=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154576882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEWIS FAMILY CHIROPRACTIC & WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2008
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3214 50TH STREET CT NW STE. 204
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-8589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-858-9783
-----------------------------------------------------
Fax | 253-444-3783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3214 50TH STREET CT NW STE. 204
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-8589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-858-9783
-----------------------------------------------------
Fax | 253-444-3783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DUSTIN LEWIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 253-858-9783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034759
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------