Provider Demographics
NPI:1033198478
Name:CARTER, BENJAMIN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RYAN
Last Name:CARTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MAIN ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-1215
Mailing Address - Country:US
Mailing Address - Phone:319-367-5966
Mailing Address - Fax:
Practice Address - Street 1:107 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:IA
Practice Address - Zip Code:52645-1215
Practice Address - Country:US
Practice Address - Phone:319-367-5854
Practice Address - Fax:319-367-2064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18316OtherWELLMARK BCBS
U81404Medicare UPIN
IAI0030Medicare ID - Type Unspecified