Provider Demographics
NPI:1215955521
Name:QUIROZ, BENJAMIN CASEY (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CASEY
Last Name:QUIROZ
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 1:100 N N ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6409
Mailing Address - Country:US
Mailing Address - Phone:432-262-2440
Mailing Address - Fax:
Practice Address - Street 1:100 N N ST
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6409
Practice Address - Country:US
Practice Address - Phone:432-262-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08S513101OtherBLUE CROSS BLUE SHIELD
TX8F2435Medicare ID - Type UnspecifiedPERSONAL NUMBER