Provider Demographics
NPI:1689030249
Name:DIEFFENBACHER, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:DIEFFENBACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13865 S DIXIE HWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7221
Mailing Address - Country:US
Mailing Address - Phone:305-252-9090
Mailing Address - Fax:305-252-9058
Practice Address - Street 1:430 S DIXIE HWY STE 211
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2200
Practice Address - Country:US
Practice Address - Phone:786-502-2173
Practice Address - Fax:786-221-3628
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor