Healthcare Provider Details

I. General information

NPI: 1962462697
Provider Name (Legal Business Name): CHARLES R. LEMON DC DC, DACBN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 3RD ST
BEAVER PA
15009-2350
US

IV. Provider business mailing address

265 3RD ST
BEAVER PA
15009-2350
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-6333
  • Fax: 724-774-8844
Mailing address:
  • Phone: 724-774-6333
  • Fax: 724-774-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC00416L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDC-OO4164-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: