Provider Demographics
NPI:1295858801
Name:ANDERSON, BEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:ANDERSON
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 1:1600 W 38TH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6406
Mailing Address - Country:US
Mailing Address - Phone:281-635-9634
Mailing Address - Fax:
Practice Address - Street 1:609 CASTLE RIDGE RD STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5126
Practice Address - Country:US
Practice Address - Phone:512-328-4041
Practice Address - Fax:512-328-5114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor