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General NPI Number Information
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NPI Number | 1518084995
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Entity Type | Individual
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Provider Name | DAVID B LEWIS NCMMT
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6884 REDWOOD RD
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City | WEST JORDAN
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State | UT
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Zip | 84084-2405
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Country | US
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Telephone | 801-495-4490
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Fax | 801-495-4493
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Provider Business Mailing Address
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Address Line | 952 BLOOMSBURY CV
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City | MURRAY
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State | UT
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Zip | 84123-7605
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Country | US
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Telephone | 801-261-1672
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 5567738-4701
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License Number State | UT
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