Provider Demographics
NPI:1043892128
Name:CUTLER, BENJAMIN MAXFIELD (DC, MS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MAXFIELD
Last Name:CUTLER
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12044 S GENOVA DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6111
Mailing Address - Country:US
Mailing Address - Phone:801-803-8340
Mailing Address - Fax:
Practice Address - Street 1:12176 S 1000 E STE 10
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-3221
Practice Address - Country:US
Practice Address - Phone:801-396-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12236251-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor