Provider Demographics
NPI:1518989631
Name:SHIER, BENJAMIN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:SHIER
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 1:707 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3027
Mailing Address - Country:US
Mailing Address - Phone:920-821-0071
Mailing Address - Fax:920-821-0072
Practice Address - Street 1:211 CORPORATE DR
Practice Address - Street 2:SUITE H
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3119
Practice Address - Country:US
Practice Address - Phone:920-821-0071
Practice Address - Fax:920-821-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4138012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035837Medicare PIN
WIU05340Medicare UPIN