Provider Demographics
NPI:1619407988
Name:SCHLEETER, BENJAMIN A (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:SCHLEETER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:A
Other - Last Name:SCHLEETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4014 COMMONS DR W STE 114
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8425
Mailing Address - Country:US
Mailing Address - Phone:850-654-8770
Mailing Address - Fax:850-654-1056
Practice Address - Street 1:4014 COMMONS DR W STE 114
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8425
Practice Address - Country:US
Practice Address - Phone:850-654-8770
Practice Address - Fax:850-654-1056
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor