MEDICARE: LEWIS FAMILY CHIROPRACTIC & WELLNESS, PLLC

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	111N00000X	Chiropractor	CH00034759	WA

General Provider Information

NPI Number	:	1154576882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY CHIROPRACTIC & WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	3214 50TH STREET CT NW
Second Line	:	STE. 204
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-858-9783
Fax Number	:	253-444-3783

Provider Business Practice Location Address
First Line	:	3214 50TH STREET CT NW
Second Line	:	STE. 204
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-858-9783
Fax Number	:	253-444-3783

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DUSTIN LEWIS
Credential	:	DC
Telephone Number	:	253-858-9783

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	12/21/2010

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