Provider Demographics
NPI:1922232495
Name:VOTH, BENJAMIN LEVI (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LEVI
Last Name:VOTH
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 1:1957 THOMPSON RD STE B
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2031
Mailing Address - Country:US
Mailing Address - Phone:541-266-8000
Mailing Address - Fax:
Practice Address - Street 1:1957 THOMPSON RD STE B
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2031
Practice Address - Country:US
Practice Address - Phone:541-266-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR159396Medicare PIN