Provider Demographics
NPI:1396828372
Name:BENSON, ERIC ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANTHONY
Last Name:BENSON
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 1:527 N DIERS AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4977
Mailing Address - Country:US
Mailing Address - Phone:308-384-4335
Mailing Address - Fax:308-384-1888
Practice Address - Street 1:527 N DIERS AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4977
Practice Address - Country:US
Practice Address - Phone:308-384-4335
Practice Address - Fax:308-384-1888
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47072764413Medicaid
NET90018Medicare UPIN
NE47072764413Medicaid