Provider Demographics
NPI:1114047594
Name:BENSON, CLIFFORD R (DC)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:R
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0326
Mailing Address - Country:US
Mailing Address - Phone:601-749-4939
Mailing Address - Fax:769-301-1641
Practice Address - Street 1:6682 HIGHWAY 11 STE 103
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7992
Practice Address - Country:US
Practice Address - Phone:601-749-4939
Practice Address - Fax:769-301-1641
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS01-05820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health