MEDICARE: DR. JEWA MARIA LEA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	1976	MD

General Provider Information

NPI Number	:	1083616361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEWA MARIA LEA DC

Provider Business Mailing Address
First Line	:	12501 SILVERBIRCH LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2508
Country	:	US
Telephone Number	:	301-421-1420
Fax Number	:	301-421-1426

Provider Business Practice Location Address
First Line	:	15202 DINO DR
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1172
Country	:	US
Telephone Number	:	301-421-1420
Fax Number	:	301-421-1426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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