Provider Demographics
NPI:1477627214
Name:BENAVIDES, VICTOR ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:BENAVIDES
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 1:5912 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-1602
Mailing Address - Country:US
Mailing Address - Phone:281-998-6045
Mailing Address - Fax:281-998-0558
Practice Address - Street 1:5912 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1602
Practice Address - Country:US
Practice Address - Phone:281-998-6045
Practice Address - Fax:281-998-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6142111NS0005X
CADC 22588111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU51040Medicare UPIN