Provider Demographics
NPI:1104418177
Name:LEWIS, CEDAR ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:CEDAR
Middle Name:ELLEN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 27TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3349
Mailing Address - Country:US
Mailing Address - Phone:605-644-9074
Mailing Address - Fax:605-722-0306
Practice Address - Street 1:311 N 27TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3349
Practice Address - Country:US
Practice Address - Phone:605-644-9074
Practice Address - Fax:605-722-0306
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1497828313Medicaid