Provider Demographics
NPI:1669929568
Name:LEWIS, JEROME II (DC)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:LEWIS
Suffix:II
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 1:816 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1215
Mailing Address - Country:US
Mailing Address - Phone:706-399-9083
Mailing Address - Fax:
Practice Address - Street 1:816 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1215
Practice Address - Country:US
Practice Address - Phone:706-589-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4675111N00000X
GACHIR010307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor