Provider Demographics
NPI:1427066505
Name:LEWIS, MARVIN JEROME (DC)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:JEROME
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 1:3334 FM 1092 RD STE 450
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2298
Mailing Address - Country:US
Mailing Address - Phone:281-499-0123
Mailing Address - Fax:281-499-0240
Practice Address - Street 1:3334 FM 1092 RD STE 450
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2298
Practice Address - Country:US
Practice Address - Phone:281-499-0123
Practice Address - Fax:281-499-0240
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601553OtherBLUE CROSS & BLUE SHIELD
TX0004010630OtherAETNA
TX697141OtherUNITED HEALTHCARE
TX697141OtherUNITED HEALTHCARE
TXT14405Medicare UPIN