Provider Demographics
NPI:1013969724
Name:BENSON, TIMOTHY S (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
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 1:2150 302ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9708
Mailing Address - Country:US
Mailing Address - Phone:319-372-4204
Mailing Address - Fax:319-376-1204
Practice Address - Street 1:2150 302ND AVE
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9708
Practice Address - Country:US
Practice Address - Phone:319-372-4204
Practice Address - Fax:319-376-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0066993Medicaid
IA45997OtherBLUE CROSS
IA00657Medicare PIN