Provider Demographics
NPI:1649643453
Name:KNODERER, BENJAMIN J (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:KNODERER
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 1:3333 MASSILLON RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5981
Mailing Address - Country:US
Mailing Address - Phone:330-896-2030
Mailing Address - Fax:330-899-0527
Practice Address - Street 1:3333 MASSILLON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5981
Practice Address - Country:US
Practice Address - Phone:330-896-2030
Practice Address - Fax:330-899-0527
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor