Provider Demographics
NPI:1508066051
Name:SANTILLAN, BENITO (DC)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:
Last Name:SANTILLAN
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 1:8670 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2924
Mailing Address - Country:US
Mailing Address - Phone:310-855-0752
Mailing Address - Fax:310-855-0753
Practice Address - Street 1:8670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2924
Practice Address - Country:US
Practice Address - Phone:310-855-0752
Practice Address - Fax:310-855-0753
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23169OtherSTATE LIC.