Provider Demographics
NPI:1891758595
Name:BENHAM, DAVID W (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BENHAM
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 1:575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1571
Mailing Address - Country:US
Mailing Address - Phone:207-283-0232
Mailing Address - Fax:207-286-8643
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1571
Practice Address - Country:US
Practice Address - Phone:207-283-0232
Practice Address - Fax:207-286-8643
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000643OtherBC/BS PROVIDER #
ME000643OtherBC/BS PROVIDER #