Provider Demographics
NPI:1306842638
Name:BUETTENBACK, BEN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:ROBERT
Last Name:BUETTENBACK
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 1:5533 NW 1ST ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4474
Mailing Address - Country:US
Mailing Address - Phone:402-476-8483
Mailing Address - Fax:402-742-3783
Practice Address - Street 1:5533 NW 1ST ST
Practice Address - Street 2:STE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4474
Practice Address - Country:US
Practice Address - Phone:402-476-8483
Practice Address - Fax:402-742-3783
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09611OtherBLUE CROSS BLUE SHIELD NE
NEU99669Medicare UPIN
NE09611OtherBLUE CROSS BLUE SHIELD NE
NE278753Medicare ID - Type Unspecified