Provider Demographics
NPI:1528003928
Name:TROWBRIDGE, BENJAMIN JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JASON
Last Name:TROWBRIDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:JASON
Other - Last Name:TROWBRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:85 LOOP 150 W
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3930
Mailing Address - Country:US
Mailing Address - Phone:512-332-2777
Mailing Address - Fax:512-332-2701
Practice Address - Street 1:85 LOOP 150 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3930
Practice Address - Country:US
Practice Address - Phone:512-332-2777
Practice Address - Fax:512-332-2701
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087RCOtherBLUE CROSS BLUE SHIELD
TX652934OtherUNITED HEALTHCARE INSURANCE
TX8F4670Medicare PIN
TXU92535Medicare UPIN