Provider Demographics
NPI:1003400953
Name:ZEDLER, BENJAMIN R (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:ZEDLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:R
Other - Last Name:ZEDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6915 S. RED RD. STE. 227
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:786-227-9402
Mailing Address - Fax:786-254-7740
Practice Address - Street 1:6915 S. RED RD. STE. 227
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-227-9402
Practice Address - Fax:786-254-7740
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2022-10-24
Deactivation Date:2021-04-09
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
FLCH12629111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH12627OtherCH12627
FL1003400953OtherCHIROPRACTIC