MEDICARE: DANIEL J LEWIS D.C. LLC

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	CH11226	FL

General Provider Information

NPI Number	:	1215386040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL J LEWIS D.C. LLC

Provider Business Mailing Address
First Line	:	1234 NE 4TH AVE STE B
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1977
Country	:	US
Telephone Number	:	549-507-9380
Fax Number	:	954-522-5543

Provider Business Practice Location Address
First Line	:	1234 NE 4TH AVE STE B
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1977
Country	:	US
Telephone Number	:	954-507-9380
Fax Number	:	954-522-5543

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL J LEWIS
Credential	:	DC
Telephone Number	:	954-507-9380

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	12/12/2019

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