Provider Demographics
NPI:1790429314
Name:SUMMERLIN, BENJAMIN RYAN (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RYAN
Last Name:SUMMERLIN
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 1:1364 INTERSTATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6187
Mailing Address - Country:US
Mailing Address - Phone:931-456-8880
Mailing Address - Fax:931-456-8883
Practice Address - Street 1:1364 INTERSTATE DR STE 101
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6187
Practice Address - Country:US
Practice Address - Phone:931-456-8880
Practice Address - Fax:931-456-8883
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor