Provider Demographics
NPI:1912913443
Name:BALAREZO, BENJAMIN C (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:C
Last Name:BALAREZO
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 1:1801 NE 164TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4109
Mailing Address - Country:US
Mailing Address - Phone:305-454-9610
Mailing Address - Fax:305-705-3524
Practice Address - Street 1:1801 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4109
Practice Address - Country:US
Practice Address - Phone:305-454-9610
Practice Address - Fax:305-705-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor