Provider Demographics
NPI:1316143811
Name:LEWANDOSKY, PAUL MICHEAL (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHEAL
Last Name:LEWANDOSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5600
Mailing Address - Country:US
Mailing Address - Phone:602-867-4631
Mailing Address - Fax:
Practice Address - Street 1:3131 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5600
Practice Address - Country:US
Practice Address - Phone:602-867-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3992111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1894544360Medicare ID - Type Unspecified