Provider Demographics
NPI:1164569927
Name:LEMESH, BRIAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:LEMESH
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 1:1580 E WASHINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3679
Mailing Address - Country:US
Mailing Address - Phone:707-762-5425
Mailing Address - Fax:
Practice Address - Street 1:1580 E WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3679
Practice Address - Country:US
Practice Address - Phone:707-762-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0254630Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAU83993Medicare UPIN