Provider Demographics
NPI:1558580720
Name:BENJAMIN, RODRIGUE (DC)
Entity Type:Individual
Prefix:
First Name:RODRIGUE
Middle Name:
Last Name:BENJAMIN
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 1:100 E SAMPLE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3554
Mailing Address - Country:US
Mailing Address - Phone:954-788-8882
Mailing Address - Fax:954-582-9855
Practice Address - Street 1:100 E SAMPLE RD STE 130
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3554
Practice Address - Country:US
Practice Address - Phone:954-788-8882
Practice Address - Fax:954-582-9855
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88348OtherBLUE CROSS BLUE SHIELD
FLU4186Medicare ID - Type UnspecifiedPROVIDER NUMBER
FLK7120Medicare ID - Type UnspecifiedGROUP NUMBER