Provider Demographics
NPI:1083778575
Name:BENSON, CLARK EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:EDWARD
Last Name:BENSON
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 1:685 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3439
Mailing Address - Country:US
Mailing Address - Phone:608-348-7771
Mailing Address - Fax:608-348-7773
Practice Address - Street 1:685 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3439
Practice Address - Country:US
Practice Address - Phone:608-348-7771
Practice Address - Fax:608-348-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010824111N00000X
WI4542-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor