Provider Demographics
NPI:1841387487
Name:GALYARDT, BENJAMIN LEWIS (DC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEWIS
Last Name:GALYARDT
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 1:110 W HARVARD ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5217
Mailing Address - Country:US
Mailing Address - Phone:970-282-1173
Mailing Address - Fax:970-282-1175
Practice Address - Street 1:110 W HARVARD ST
Practice Address - Street 2:STE. 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5217
Practice Address - Country:US
Practice Address - Phone:970-282-1173
Practice Address - Fax:970-282-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor