Provider Demographics
NPI:1245201649
Name:ANDRULOT, BENJAMIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:ANDRULOT
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 1:40 BLUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1333
Mailing Address - Country:US
Mailing Address - Phone:508-240-7600
Mailing Address - Fax:508-240-7686
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2424
Practice Address - Country:US
Practice Address - Phone:508-240-7600
Practice Address - Fax:508-240-7686
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2879111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1600541OtherMASSHEALTH
MA7335964OtherAETNA HEALTHCARE
MA1660669OtherCIGNA HEALTHCARE
MAY37048OtherBCBS OF MA
MAAA80633OtherHARVARD PILGRIM HEALTH
MA1660669OtherCIGNA HEALTHCARE
MAY37048OtherBCBS OF MA