Provider Demographics
NPI:1831580158
Name:BENSON CHIROPRACTIC
Entity type:Organization
Organization Name:BENSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-230-1700
Mailing Address - Street 1:824 UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3547
Mailing Address - Country:US
Mailing Address - Phone:218-230-1700
Mailing Address - Fax:
Practice Address - Street 1:824 UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3547
Practice Address - Country:US
Practice Address - Phone:218-230-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN713609OtherMEDICARE PTAN
ND14826Medicaid