Provider Demographics
NPI:1770648206
Name:BERKEY, BENJAMIN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LEE
Last Name:BERKEY
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 1:2900 THOMAS AVE S
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4477
Mailing Address - Country:US
Mailing Address - Phone:612-928-7894
Mailing Address - Fax:612-915-1439
Practice Address - Street 1:2900 THOMAS AVE S
Practice Address - Street 2:SUITE 330
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4477
Practice Address - Country:US
Practice Address - Phone:612-928-7894
Practice Address - Fax:612-915-1439
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor