1063688927 NPI number — BENSON CHIROPRACTIC, PC

Table of content: (NPI 1063688927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063688927 NPI number — BENSON CHIROPRACTIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENSON CHIROPRACTIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHIROPRACTIC PROFESSIONALS OF COLUMBIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063688927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 ELMWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-888-6221
Provider Business Mailing Address Fax Number:
803-888-6221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 ELMWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-888-6221
Provider Business Practice Location Address Fax Number:
803-888-6221
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON II
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
803-667-8332

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  018049 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 010294 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C10294-9B . This is a "NEW YORK STATE WORKER'S COMPENSATION BOARD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113490AN . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X8L55 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000980590001 . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 835773 . This is a "MANAGED PHYSICAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010010849 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 629920 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010111294 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 175965AN . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7538368 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C10849-OB . This is a "NEW YORK STATE WORKER'S COMPENSATION BOARD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P020111294 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 629920 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 629921 . This is a "AMERICAN CHIROPRACTIC NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7538368 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P020010849 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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