Provider Demographics
NPI:1225185838
Name:MORGAN, BENJAMIN PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PHILIP
Last Name:MORGAN
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 1:240 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IL
Mailing Address - Zip Code:62341-1615
Mailing Address - Country:US
Mailing Address - Phone:217-847-3132
Mailing Address - Fax:
Practice Address - Street 1:240 N 14TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IL
Practice Address - Zip Code:62341-1615
Practice Address - Country:US
Practice Address - Phone:217-847-3132
Practice Address - Fax:217-847-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005033111N00000X
IAA5339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038005033Medicaid
IL3482006OtherBLUE CROSS BLUE SHIELD
IA0907717Medicaid
IL730970Medicare ID - Type UnspecifiedWISCONSIN PHYICIANS SERVI
IL038005033Medicaid
IL3482006OtherBLUE CROSS BLUE SHIELD