Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC17737 | CA |
NPI | 1003800863 |
---|---|
Provider Name | Sam Martin Lerner |
First Address | San Diego, CA 92101-1596 |
Second Address | San Diego, CA 92101-1596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U16911 | (02) |