1710078316 NPI number — DR. CARSON BENJAMIN D.C.

Table of content: DR. CARSON BENJAMIN D.C. (NPI 1710078316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710078316 NPI number — DR. CARSON BENJAMIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENJAMIN
Provider First Name:
CARSON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1710078316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 CENTRAL AVE NE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55418-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-782-0173
Provider Business Mailing Address Fax Number:
612-782-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 CENTRAL AVE NE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55418-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-782-0173
Provider Business Practice Location Address Fax Number:
612-782-0196
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4105 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62G21BE . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".