Provider Demographics
NPI:1669039889
Name:BENJAMIN, PRESTON RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:RAY
Last Name:BENJAMIN
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 1:12995 SHERIDAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1488
Mailing Address - Country:US
Mailing Address - Phone:419-309-1118
Mailing Address - Fax:
Practice Address - Street 1:12995 SHERIDAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1488
Practice Address - Country:US
Practice Address - Phone:419-309-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor