Provider Demographics
NPI:1396899142
Name:STOREY, BENJAMIN S (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:S
Last Name:STOREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 COLLEGE HILLS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8474
Mailing Address - Country:US
Mailing Address - Phone:325-949-1518
Mailing Address - Fax:325-223-9290
Practice Address - Street 1:2412 COLLEGE HILLS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8474
Practice Address - Country:US
Practice Address - Phone:325-949-1518
Practice Address - Fax:325-223-9290
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605727Medicare ID - Type Unspecified
TXU67200Medicare UPIN