Provider Demographics
NPI:1164519765
Name:DORENKAMP, BENJAMIN WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WAYNE
Last Name:DORENKAMP
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 1:609 NORTH AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7531
Mailing Address - Country:US
Mailing Address - Phone:970-242-7700
Mailing Address - Fax:970-242-7711
Practice Address - Street 1:609 NORTH AVE
Practice Address - Street 2:STE 1
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7531
Practice Address - Country:US
Practice Address - Phone:970-242-7700
Practice Address - Fax:970-242-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC26143Medicare UPIN
COC26143Medicare ID - Type UnspecifiedMEDICARE