Provider Demographics
NPI:1750701124
Name:HERRON, BENJAMIN (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HERRON
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 1:170 S 2ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1673
Mailing Address - Country:US
Mailing Address - Phone:541-290-8696
Mailing Address - Fax:541-808-2362
Practice Address - Street 1:170 S 2ND ST STE 205
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1673
Practice Address - Country:US
Practice Address - Phone:541-290-8696
Practice Address - Fax:541-808-2362
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4430111N00000X
OR5122111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor