Provider Demographics
NPI:1467529339
Name:BENTON, KAREN S (DC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:BENTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21351 GENTRY DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8510
Mailing Address - Country:US
Mailing Address - Phone:703-406-8686
Mailing Address - Fax:703-406-8688
Practice Address - Street 1:21351 GENTRY DR
Practice Address - Street 2:SUITE 125
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8510
Practice Address - Country:US
Practice Address - Phone:703-406-8686
Practice Address - Fax:703-406-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555596111N00000X
MD01949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA641092OtherACN
VA219755OtherANTHEM
VA376341OtherMAMSI
VA219755OtherANTHEM