Provider Demographics
NPI:1659674521
Name:MATHESON, BENJAMIN J (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:MATHESON
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 1:515 N NEEL ST
Mailing Address - Street 2:STE 105
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2256
Mailing Address - Country:US
Mailing Address - Phone:509-545-6889
Mailing Address - Fax:
Practice Address - Street 1:515 N NEEL ST STE C105
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2259
Practice Address - Country:US
Practice Address - Phone:509-783-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4070111N00000X
WACH60176125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor