Provider Demographics
NPI:1467807982
Name:INDIEK, BENJAMIN (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:INDIEK
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 1:8010 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3711
Mailing Address - Country:US
Mailing Address - Phone:913-652-6811
Mailing Address - Fax:
Practice Address - Street 1:8010 STATE LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3711
Practice Address - Country:US
Practice Address - Phone:913-652-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05773111N00000X
MO2016004526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor