MEDICARE: DR. GREGORY C LEWIS 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	111N00000X	Chiropractor	S01471	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T2200003	OTHER	MD	BLUE CROSS ID
2	KD80	OTHER	MD	BC OF MD ID
3	4334359	OTHER	MD	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1386737229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY C LEWIS DC

Provider Business Mailing Address
First Line	:	403 MALCOLM DR
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6107
Country	:	US
Telephone Number	:	410-876-8885
Fax Number	:	410-876-5961

Provider Business Practice Location Address
First Line	:	403 MALCOLM DR
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6107
Country	:	US
Telephone Number	:	410-876-8885
Fax Number	:	410-876-5961

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. GREGORY C LEWIS DC” Practice Location

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