Provider Demographics
NPI:1629260518
Name:JOHNSON, BENJAMIN WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WESLEY
Last Name:JOHNSON
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 1:3011 RALEIGH ROAD PKWY W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8213
Mailing Address - Country:US
Mailing Address - Phone:252-234-0000
Mailing Address - Fax:252-291-3232
Practice Address - Street 1:3011 RALEIGH ROAD PKWY W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8213
Practice Address - Country:US
Practice Address - Phone:252-234-0000
Practice Address - Fax:252-291-3232
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor