=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942331327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE I D LEWIS D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 01/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2217 E EVERGREEN BLVD
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-253-5621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 NE 6TH AVE
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-901-3394
-----------------------------------------------------
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 | CH00034729
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------