Provider Demographics
NPI:1386737229
Name:LEWIS, GREGORY C (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:LEWIS
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 1:403 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6107
Mailing Address - Country:US
Mailing Address - Phone:410-876-8885
Mailing Address - Fax:410-876-5961
Practice Address - Street 1:403 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6107
Practice Address - Country:US
Practice Address - Phone:410-876-8885
Practice Address - Fax:410-876-5961
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT2200003OtherBLUE CROSS ID
MDKD80OtherBC OF MD ID
MD4334359OtherAETNA PROVIDER NUMBER
U30639Medicare UPIN
MD4334359OtherAETNA PROVIDER NUMBER