Provider Demographics
NPI:1477632032
Name:BADDING-BENTON, JENNIFER JEAN (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:BADDING-BENTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N PHILADELPHIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2513
Mailing Address - Country:US
Mailing Address - Phone:410-273-5900
Mailing Address - Fax:410-273-5972
Practice Address - Street 1:110 N PHILADELPHIA BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001
Practice Address - Country:US
Practice Address - Phone:410-273-5900
Practice Address - Fax:410-273-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
F533001OtherCAREFIRST BLUE CHOICE
M671ABOtherCAREFIRST BCBS
M671ABOtherCAREFIRST BCBS
473RMedicare ID - Type Unspecified