Provider Demographics
NPI:1407291461
Name:BEHRENDT, BENJAMIN (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BEHRENDT
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 1:4000 RIVERLOOK PKWY SE
Mailing Address - Street 2:UNIT 208
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4846
Mailing Address - Country:US
Mailing Address - Phone:906-361-2348
Mailing Address - Fax:
Practice Address - Street 1:4000 RIVERLOOK PKWY SE
Practice Address - Street 2:UNIT 208
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4846
Practice Address - Country:US
Practice Address - Phone:906-361-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009123111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology