Provider Demographics
NPI:1225594344
Name:PENTON, BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:PENTON
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 1:2326 EVERGLADE RD
Mailing Address - Street 2:
Mailing Address - City:MORSE
Mailing Address - State:LA
Mailing Address - Zip Code:70559-2100
Mailing Address - Country:US
Mailing Address - Phone:337-458-1120
Mailing Address - Fax:
Practice Address - Street 1:1011 N AVENUE G
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3733
Practice Address - Country:US
Practice Address - Phone:337-250-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor