Provider Demographics
NPI:1447006721
Name:LEWIS, DENVER J (DC)
Entity type:Individual
Prefix:DR
First Name:DENVER
Middle Name:J
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 1:3015 E NEW YORK ST STE A12
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5163
Mailing Address - Country:US
Mailing Address - Phone:817-681-9039
Mailing Address - Fax:
Practice Address - Street 1:3015 E NEW YORK ST STE A12
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5163
Practice Address - Country:US
Practice Address - Phone:817-681-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12937246-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor