Provider Demographics
NPI:1881930923
Name:WILLIAMSON, BENJAMIN PAUL (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PAUL
Last Name:WILLIAMSON
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 1:2717 N 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1847
Mailing Address - Country:US
Mailing Address - Phone:928-774-1463
Mailing Address - Fax:
Practice Address - Street 1:2717 N 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1847
Practice Address - Country:US
Practice Address - Phone:928-774-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor