Provider Demographics
NPI:1043403793
Name:DUKE, BENJAMIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:DUKE
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 1:1515 SHERIDAN RD
Mailing Address - Street 2:ARCADE UNIT 20-21
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1822
Mailing Address - Country:US
Mailing Address - Phone:847-920-4544
Mailing Address - Fax:847-920-5754
Practice Address - Street 1:1515 SHERIDAN RD
Practice Address - Street 2:ARCADE UNIT 20-21
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1822
Practice Address - Country:US
Practice Address - Phone:847-920-4544
Practice Address - Fax:847-920-5754
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400094300OtherMEDICARE GROUP MEMBER PTAN
ILF100094293OtherMEDICARE GROUP/ORGANIZATION PROVIDER TRANSACTION ACCESS NUMBER PTAN
IL9932411OtherBCBS
IL1605587OtherBCBS IL
ILF400094300OtherMEDICARE GROUP MEMBER PTAN
IL213345Medicare PIN