MEDICARE: DR. CHARLES IRVIN LENZ D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1850	NM

General Provider Information

NPI Number	:	1043529027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES IRVIN LENZ D.C.

Provider Business Mailing Address
First Line	:	1700 E AMADOR AVE
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3119
Country	:	US
Telephone Number	:	575-652-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 E AMADOR AVE
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3119
Country	:	US
Telephone Number	:	575-652-4092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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