Provider Demographics
NPI:1609267111
Name:LEWIS, MARK LOWELL (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LOWELL
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 1:116 W ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-5702
Mailing Address - Country:US
Mailing Address - Phone:575-578-2811
Mailing Address - Fax:
Practice Address - Street 1:116 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5702
Practice Address - Country:US
Practice Address - Phone:575-578-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor