Provider Demographics
NPI:1598974586
Name:TANNER, BENJAMIN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:TANNER
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 1:16 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-1604
Mailing Address - Country:US
Mailing Address - Phone:717-665-1888
Mailing Address - Fax:717-665-3802
Practice Address - Street 1:16 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-1604
Practice Address - Country:US
Practice Address - Phone:717-665-1888
Practice Address - Fax:717-665-3802
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001674L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATA084734Medicare ID - Type UnspecifiedPROVIDER #