Provider Demographics
NPI:1962462697
Name:LEMON DC, CHARLES R (DC, DACBN)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:LEMON DC
Suffix:
Gender:M
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2350
Mailing Address - Country:US
Mailing Address - Phone:724-774-6333
Mailing Address - Fax:724-774-8844
Practice Address - Street 1:265 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2350
Practice Address - Country:US
Practice Address - Phone:724-774-6333
Practice Address - Fax:724-774-8844
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-OO4164-L133N00000X
PADC00416L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000171659600Medicaid
PA000171659600Medicaid
PA584131Medicare PIN