Provider Demographics
NPI:1477655728
Name:LERNER, CHARLES B (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
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:PO BOX 281
Mailing Address - Street 2:853 BANTAM RD
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-0281
Mailing Address - Country:US
Mailing Address - Phone:860-567-2300
Mailing Address - Fax:860-567-2430
Practice Address - Street 1:853 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-0281
Practice Address - Country:US
Practice Address - Phone:860-567-2300
Practice Address - Fax:860-567-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000619111N00000X
CA17954111N00000X
OR2270111N00000X
NYX005185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000564Medicare ID - Type UnspecifiedCHIROPRACTOR
CTT06597Medicare UPIN