Basic Information
| Provider Information | |||||||||
| NPI: | 1003800863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LERNER | ||||||||
| FirstName: | SAM | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 1ST AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921011596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192358000 | ||||||||
| FaxNumber: | 6193388178 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 1ST AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921011596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192358000 | ||||||||
| FaxNumber: | 6193388178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC17737 | CA | Y | Chiropractic Providers | Chiropractor |
No ID Information.