=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154657831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEW CHIROPRACTIC & WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2009
-----------------------------------------------------
Last Update Date | 10/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 SCHANCK RD SUITE E
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-5309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-577-9696
-----------------------------------------------------
Fax | 732-577-1131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 SCHANCK RD SUITE E
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-5309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-577-9696
-----------------------------------------------------
Fax | 732-577-1131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. PETER LEW
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 732-577-9696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | MC04756
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------