Provider Demographics
NPI:1720170194
Name:STUKEL, BENJAMIN ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:STUKEL
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 1:34605 284TH ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523
Mailing Address - Country:US
Mailing Address - Phone:605-775-9077
Mailing Address - Fax:
Practice Address - Street 1:114 E 6TH ST
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533
Practice Address - Country:US
Practice Address - Phone:605-835-8737
Practice Address - Fax:605-835-8738
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601972Medicaid
NE10025344000OtherMEDICAID
SDS100602Medicare PIN
V06832Medicare UPIN