Provider Demographics
NPI:1598823189
Name:HANER, BENJAMIN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:HANER
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 1:6103 BALTIMORE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1966
Mailing Address - Country:US
Mailing Address - Phone:240-467-5600
Mailing Address - Fax:240-467-5626
Practice Address - Street 1:6103 BALTIMORE AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:240-467-5600
Practice Address - Fax:240-467-5626
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor