Individual
DR. JACOB DEWAYNE LEWALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
714 STATE HIGHWAY 248 STE 503, BRANSON, MO 65616-3761
(417) 872-7728
Mailing address
1351 TILDEN RD, GALENA, MO 65656-8633
(417) 872-7728
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2020012893
MO
Other
Enumeration date
05/21/2020
Last updated
05/21/2020
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