Provider Demographics
NPI:1245321843
Name:HERR, BENJAMIN SU (DC, NMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SU
Last Name:HERR
Suffix:
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 E SOUTHGATE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2628
Mailing Address - Country:US
Mailing Address - Phone:916-393-5059
Mailing Address - Fax:916-393-4952
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:SUITE 405
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-393-5059
Practice Address - Fax:916-393-4952
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0277730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0277730Medicaid