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General NPI Number Information
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NPI Number | 1548593239
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Entity Type | Individual
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Provider Name | KEVIN DALE LEWIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 753 SW 11TH ST APT A
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City | REDMOND
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State | OR
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Zip | 97756-2632
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Country | US
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Telephone | 541-526-1488
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Fax | 541-322-6800
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Provider Business Mailing Address
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Address Line | 561 NE BELLEVUE DR STE 102
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City | BEND
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State | OR
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Zip | 97701-7696
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Country | US
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Telephone | 541-330-7080
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Fax | 541-330-7081
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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 | 3952
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License Number State | OR
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