Provider Demographics
NPI:1972533693
Name:ERESE, BENJAMIN WALTER II (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WALTER
Last Name:ERESE
Suffix:II
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 1:1122 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3614
Mailing Address - Country:US
Mailing Address - Phone:704-636-0741
Mailing Address - Fax:704-636-0793
Practice Address - Street 1:1122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3614
Practice Address - Country:US
Practice Address - Phone:704-636-0741
Practice Address - Fax:704-636-0793
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085CEMedicaid
NC89085CEMedicaid
NC2456171Medicare PIN