Provider Demographics
NPI:1801900097
Name:DICKINSON, BENJAMIN BLAIR (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BLAIR
Last Name:DICKINSON
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 1:7135 E 500 S
Mailing Address - Street 2:
Mailing Address - City:FRANCISCO
Mailing Address - State:IN
Mailing Address - Zip Code:47649-9155
Mailing Address - Country:US
Mailing Address - Phone:812-491-7777
Mailing Address - Fax:812-491-7877
Practice Address - Street 1:3101 N GREEN RIVER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1369
Practice Address - Country:US
Practice Address - Phone:812-491-7777
Practice Address - Fax:812-491-7877
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002026A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000307759OtherANTHEM
INU97263Medicare UPIN
IN000000307759OtherANTHEM