MEDICARE: LESTER LICHT DC PC

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	000534	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568458420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER LICHT DC PC

Provider Business Mailing Address
First Line	:	1055 BOSTON POST RD
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1744
Country	:	US
Telephone Number	:	203-933-3933
Fax Number	:	203-932-6557

Provider Business Practice Location Address
First Line	:	1055 BOSTON POST RD
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1744
Country	:	US
Telephone Number	:	203-933-3933
Fax Number	:	203-932-6557

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LESTER LICHT
Credential	:	DC
Telephone Number	:	203-933-3933

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	08/22/2020

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