Provider Demographics
NPI:1508872862
Name:LERNER, BENJAMIN (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
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 1:604 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4675
Mailing Address - Country:US
Mailing Address - Phone:321-939-2328
Mailing Address - Fax:321-939-2033
Practice Address - Street 1:604 FRONT ST
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4675
Practice Address - Country:US
Practice Address - Phone:321-939-2328
Practice Address - Fax:321-939-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22783OtherBCBS
22783OtherBCBS