=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598856098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE ALEXANDER LEWIS DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 N ELAM AVE SUITE 201
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27403-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-294-8383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 N ELAM AVE SUITE 201
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27403-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-294-8383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1094
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------