Provider Demographics
NPI:1942339577
Name:BENSON, RONALD M (DC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:M
Last Name:BENSON
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 1:2471 BERRYESSA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1300
Mailing Address - Country:US
Mailing Address - Phone:408-258-0812
Mailing Address - Fax:408-258-4550
Practice Address - Street 1:2471 BERRYESSA RD STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1300
Practice Address - Country:US
Practice Address - Phone:408-258-0812
Practice Address - Fax:408-258-4550
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0182130Medicare ID - Type UnspecifiedMEDICARE ID #