Provider Demographics
NPI:1134706062
Name:SHIVERS, BENJAMIN (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SHIVERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:SHIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1156 MAGNOLIA WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2200
Mailing Address - Country:US
Mailing Address - Phone:678-656-8859
Mailing Address - Fax:
Practice Address - Street 1:3200 POINTE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3370
Practice Address - Country:US
Practice Address - Phone:770-744-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor