Provider Demographics
NPI:1326129974
Name:BENZINGER, SHAWN R (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:BENZINGER
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 1:7207 N SHADELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2881
Mailing Address - Country:US
Mailing Address - Phone:317-872-2989
Mailing Address - Fax:317-872-3363
Practice Address - Street 1:7207 N SHADELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2881
Practice Address - Country:US
Practice Address - Phone:317-872-2989
Practice Address - Fax:317-872-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000901A111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100228170AMedicaid
IN225530Medicare PIN