Provider Demographics
NPI:1356326342
Name:EISENBERG, CHARLES DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DAVID
Last Name:EISENBERG
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 1:169 DANIEL WEBSTER HWY
Mailing Address - Street 2:UNIT 11
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5648
Mailing Address - Country:US
Mailing Address - Phone:603-279-6250
Mailing Address - Fax:603-279-3154
Practice Address - Street 1:169 DANIEL WEBSTER HWY
Practice Address - Street 2:UNIT 11
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5648
Practice Address - Country:US
Practice Address - Phone:603-279-6250
Practice Address - Fax:603-279-3154
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH288-1087A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6370Medicare ID - Type Unspecified