Provider Demographics
NPI:1942237557
Name:TROWBRIDGE, BENNY CLEVE (DC)
Entity Type:Individual
Prefix:DR
First Name:BENNY
Middle Name:CLEVE
Last Name:TROWBRIDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:C
Other - Last Name:TROWBRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2112 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3815
Mailing Address - Country:US
Mailing Address - Phone:325-942-7661
Mailing Address - Fax:325-942-0116
Practice Address - Street 1:2112 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3815
Practice Address - Country:US
Practice Address - Phone:325-942-7661
Practice Address - Fax:325-942-0116
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7090OtherBLUE CROSS
TX8A0440Medicare ID - Type UnspecifiedMEDICARE
TX8G7090OtherBLUE CROSS