Provider Demographics
NPI:1396077400
Name:LEWIS, CASEY (LAC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 BASILE ROWE
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2928
Mailing Address - Country:US
Mailing Address - Phone:315-569-6579
Mailing Address - Fax:315-637-3999
Practice Address - Street 1:6515 BASILE ROWE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2928
Practice Address - Country:US
Practice Address - Phone:315-569-6579
Practice Address - Fax:315-637-3999
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist