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General NPI Number Information
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NPI Number | 1295717072
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Entity Type | Individual
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Provider Name | RUSSELL JACK LEWANDOWSKI D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 2800 W. GULF TO LAKE HWY.
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City | LECANTO
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State | FL
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Zip | 34461-9205
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Country | US
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Telephone | 352-726-0888
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Fax | 352-795-8911
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Provider Business Mailing Address
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Address Line | 741 N. COUNTRY CLUB DR.
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-5405
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Country | US
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Telephone | 352-726-0888
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Fax | 352-795-8911
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH6678
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License Number State | FL
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