Provider Demographics
NPI:1164590188
Name:CLACK, BENJAMIN H (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:H
Last Name:CLACK
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 1:3180 DREDGE DR
Mailing Address - Street 2:STE C
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0561
Mailing Address - Country:US
Mailing Address - Phone:406-449-7458
Mailing Address - Fax:406-449-7496
Practice Address - Street 1:1732 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4550
Practice Address - Country:US
Practice Address - Phone:406-449-7458
Practice Address - Fax:406-449-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor