Provider Demographics
NPI:1699077222
Name:DR. LEWIS E. MOCK, CHIROPRACTOR, INC.
Entity type:Organization
Organization Name:DR. LEWIS E. MOCK, CHIROPRACTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-473-7464
Mailing Address - Street 1:1715 N WEBER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7532
Mailing Address - Country:US
Mailing Address - Phone:719-473-7464
Mailing Address - Fax:719-473-2861
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-473-7464
Practice Address - Fax:719-473-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty