Provider Demographics
NPI:1265558217
Name:BENSON, KEVIN F (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:F
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 1:19333 CHURUBUSCO LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1572
Mailing Address - Country:US
Mailing Address - Phone:301-540-8457
Mailing Address - Fax:
Practice Address - Street 1:6211 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3906
Practice Address - Country:US
Practice Address - Phone:301-231-5600
Practice Address - Fax:301-231-8640
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01875111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM567-0001Medicare UPIN
MHS8370001Medicare UPIN
MD490098Medicare ID - Type Unspecified
MD299717Medicare UPIN