Provider Demographics
NPI:1104164060
Name:BENHAM, MAGGIE RUTH (DC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:RUTH
Last Name:BENHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9751
Mailing Address - Country:US
Mailing Address - Phone:585-781-4101
Mailing Address - Fax:
Practice Address - Street 1:23 COACH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1529
Practice Address - Country:US
Practice Address - Phone:585-394-2030
Practice Address - Fax:585-394-0454
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012305-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor