Provider Demographics
NPI:1730477183
Name:LAM, BENNY B (DC)
Entity Type:Individual
Prefix:MR
First Name:BENNY
Middle Name:B
Last Name:LAM
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 1:227 W VALLEY BLVD
Mailing Address - Street 2:SUITE 258 A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3764
Mailing Address - Country:US
Mailing Address - Phone:626-782-2388
Mailing Address - Fax:626-782-2399
Practice Address - Street 1:227 W VALLEY BLVD
Practice Address - Street 2:SUITE 258 A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3764
Practice Address - Country:US
Practice Address - Phone:626-782-2388
Practice Address - Fax:626-782-2399
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor