MEDICARE: LEWIS FAMILY CHIROPRACTIC AND WELLNESS CENTER, PA

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	S03604	MD
2	111N00000X	Chiropractor	01528	MD
3	111N00000X	Chiropractor	S01471	MD

General Provider Information

NPI Number	:	1427376177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY CHIROPRACTIC AND WELLNESS CENTER, PA

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	:	OWNER/PRESIDENT
Name	:	DR. GREGORY C LEWIS
Credential	:	D.C.
Telephone Number	:	410-876-8885

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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