Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5273 | TX |
NPI | 1184780231 |
---|---|
Provider Name | Rand H. Lewis |
First Address | Weatherford, TX 76085-8802 |
Second Address | Fort Worth, TX 76116-6028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 29/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T91177 | (02) | WY |