Provider Demographics
NPI:1043794860
Name:COLTEN, BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:COLTEN
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 1:131 ROSWELL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1909
Mailing Address - Country:US
Mailing Address - Phone:770-558-6580
Mailing Address - Fax:
Practice Address - Street 1:131 ROSWELL ST STE 101
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1909
Practice Address - Country:US
Practice Address - Phone:770-558-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor