Provider Demographics
NPI:1588879951
Name:MEYERS, CHARLES R (LIC AC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:MEYERS
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:CORNISH FLAT
Mailing Address - State:NH
Mailing Address - Zip Code:03746
Mailing Address - Country:US
Mailing Address - Phone:603-442-9535
Mailing Address - Fax:
Practice Address - Street 1:2 WHIPPLE PLACE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-442-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0014171100000X
VT0000057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist