Provider Demographics
NPI:1588068951
Name:LEWIS CHIROPRACTIC GROUP, INC.
Entity type:Organization
Organization Name:LEWIS CHIROPRACTIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KARSTAN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-320-7515
Mailing Address - Street 1:510 COUNTY ROAD 466
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6341
Mailing Address - Country:US
Mailing Address - Phone:270-320-7515
Mailing Address - Fax:
Practice Address - Street 1:510 COUNTY ROAD 466
Practice Address - Street 2:SUITE 104B
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-9999
Practice Address - Country:US
Practice Address - Phone:270-320-7515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty