Provider Demographics
NPI:1114568045
Name:KING, BENJAMIN C (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:KING
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 1:1995 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9128
Mailing Address - Country:US
Mailing Address - Phone:812-460-1400
Mailing Address - Fax:812-460-1402
Practice Address - Street 1:1995 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9128
Practice Address - Country:US
Practice Address - Phone:317-745-5100
Practice Address - Fax:317-745-5100
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003120A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08003120AMedicaid