Provider Demographics
NPI:1649539222
Name:TAPPER, BENJAMIN H (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:H
Last Name:TAPPER
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 1:1512 DAKOTA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2665
Mailing Address - Country:US
Mailing Address - Phone:402-494-2141
Mailing Address - Fax:402-494-3155
Practice Address - Street 1:1512 DAKOTA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2665
Practice Address - Country:US
Practice Address - Phone:402-494-2141
Practice Address - Fax:402-494-3155
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor