Provider Demographics
NPI:1508935917
Name:BENSON, KIM FREDERICK (DC)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:FREDERICK
Last Name:BENSON
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 1:38904 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2890
Mailing Address - Country:US
Mailing Address - Phone:586-978-8240
Mailing Address - Fax:586-978-1417
Practice Address - Street 1:38904 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2890
Practice Address - Country:US
Practice Address - Phone:586-978-8240
Practice Address - Fax:586-978-1417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950F323320OtherBLUE CROSS
950F323320OtherBLUE CROSS
U35117Medicare UPIN