Provider Demographics
NPI:1396823324
Name:BLOWERS, BENJAMIN DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DALE
Last Name:BLOWERS
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:PO BOX 95
Mailing Address - Street 2:7461 MAIN ST WEST
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-0095
Mailing Address - Country:US
Mailing Address - Phone:715-866-4880
Mailing Address - Fax:715-866-8661
Practice Address - Street 1:7461 MAIN ST WEST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-0095
Practice Address - Country:US
Practice Address - Phone:715-866-4880
Practice Address - Fax:715-866-8661
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4064111N00000X
WI3843-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN223696600Medicaid
WI223696600Medicaid
MN223696600Medicaid
MN350002358Medicare ID - Type Unspecified