Provider Demographics
NPI:1952303091
Name:BENJAMIN, ROSEMARY A (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:A
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SOUTH SECOND STREET
Mailing Address - Street 2:PO BOX 289
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0289
Mailing Address - Country:US
Mailing Address - Phone:517-223-9900
Mailing Address - Fax:517-223-9900
Practice Address - Street 1:POB 289
Practice Address - Street 2:114 S. 2ND ST.
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836
Practice Address - Country:US
Practice Address - Phone:517-223-9900
Practice Address - Fax:517-223-9900
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-07-19
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MIRP005319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D710790OtherBCBSMI
MI141902466Medicaid
MIP100330OtherBLUE CARE NETWORK
MIP100330OtherBLUE CARE NETWORK
MI141902466Medicaid