Provider Demographics
NPI:1164508859
Name:COLLAMER, BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:COLLAMER
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 1:2340 GOLDEN MILE HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2710
Mailing Address - Country:US
Mailing Address - Phone:724-733-4828
Mailing Address - Fax:724-733-4218
Practice Address - Street 1:2340 GOLDEN MILE HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-2710
Practice Address - Country:US
Practice Address - Phone:724-733-4828
Practice Address - Fax:724-733-4218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005940L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor