Healthcare Provider Details

I. General information

NPI: 1356326342
Provider Name (Legal Business Name): CHARLES DAVID EISENBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 DANIEL WEBSTER HWY UNIT 11
MEREDITH NH
03253-5648
US

IV. Provider business mailing address

169 DANIEL WEBSTER HWY UNIT 11
MEREDITH NH
03253-5648
US

V. Phone/Fax

Practice location:
  • Phone: 603-279-6250
  • Fax: 603-279-3154
Mailing address:
  • Phone: 603-279-6250
  • Fax: 603-279-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number288-1087A
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: