Provider Demographics
NPI:1184159543
Name:LEWIS, NATHANIEL BENSON (DC)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:BENSON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NATHAN
Other - Middle Name:BENSON
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:207 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-3609
Mailing Address - Country:US
Mailing Address - Phone:256-734-6813
Mailing Address - Fax:256-734-6880
Practice Address - Street 1:207 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3609
Practice Address - Country:US
Practice Address - Phone:256-734-6813
Practice Address - Fax:256-734-6880
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor