Provider Demographics
NPI:1396880753
Name:BUELTER, BENJAMIN SETH (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SETH
Last Name:BUELTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:SETH
Other - Last Name:BUELTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4410 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-6086
Mailing Address - Country:US
Mailing Address - Phone:309-282-6419
Mailing Address - Fax:309-282-6003
Practice Address - Street 1:4410 N KNOXVILLE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-6086
Practice Address - Country:US
Practice Address - Phone:309-282-6419
Practice Address - Fax:309-282-6003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00007282057OtherBLUE CROSS BLUE SHIELD
IL555620Medicare ID - Type Unspecified
IL00007282057OtherBLUE CROSS BLUE SHIELD