Provider Demographics
NPI:1912070178
Name:LURIE, BENJAMIN SCOTT (DC, CCST)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:LURIE
Suffix:
Gender:M
Credentials:DC, CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370774
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0774
Mailing Address - Country:US
Mailing Address - Phone:702-547-5400
Mailing Address - Fax:702-515-0803
Practice Address - Street 1:3430 N BUFFALO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7424
Practice Address - Country:US
Practice Address - Phone:702-547-5400
Practice Address - Fax:702-515-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36571Medicare ID - Type UnspecifiedPROVIDER #
NV36570Medicare ID - Type UnspecifiedGROUP #
NVU90818Medicare UPIN