Provider Demographics
NPI:1003800863
Name:LERNER, SAM MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:MARTIN
Last Name:LERNER
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 1:2333 1ST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1596
Mailing Address - Country:US
Mailing Address - Phone:619-235-8000
Mailing Address - Fax:619-338-8178
Practice Address - Street 1:2333 1ST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1596
Practice Address - Country:US
Practice Address - Phone:619-235-8000
Practice Address - Fax:619-338-8178
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC17737Medicare ID - Type Unspecified
U16911Medicare UPIN