Provider Demographics
NPI:1316033806
Name:CAIN, BENJAMIN GERALD (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GERALD
Last Name:CAIN
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 1:1000 OMALLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3032
Mailing Address - Country:US
Mailing Address - Phone:907-349-5552
Mailing Address - Fax:907-349-5100
Practice Address - Street 1:1000 OMALLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3032
Practice Address - Country:US
Practice Address - Phone:907-349-5552
Practice Address - Fax:907-349-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH03621Medicaid
AKCH03621Medicaid
AKU87857Medicare UPIN