Provider Demographics
NPI:1285990689
Name:ATWOOD, BENJAMIN R
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7146
Mailing Address - Country:US
Mailing Address - Phone:971-207-9869
Mailing Address - Fax:
Practice Address - Street 1:16821 SE MCGILLIVRAY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0402
Practice Address - Country:US
Practice Address - Phone:360-433-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60168348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor