Provider Demographics
NPI:1508687963
Name:O'NEAL, BENJAMIN III (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:O'NEAL
Suffix:III
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 1:418 VERB ST
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1515
Mailing Address - Country:US
Mailing Address - Phone:870-672-1993
Mailing Address - Fax:
Practice Address - Street 1:13100 W BELLFORT AVE APT 1328
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4834
Practice Address - Country:US
Practice Address - Phone:870-672-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor