Provider Demographics
NPI:1972540292
Name:BENJAMIN, HOWARD J (DC)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:BENJAMIN
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 1:723 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1835
Mailing Address - Country:US
Mailing Address - Phone:610-645-9557
Mailing Address - Fax:610-645-5484
Practice Address - Street 1:723 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1835
Practice Address - Country:US
Practice Address - Phone:610-645-9557
Practice Address - Fax:610-645-5484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003856L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1681543Medicaid
PA0410198000Medicare UPIN
PA588261Medicare UPIN
PA588261Medicare ID - Type UnspecifiedMEDICARE
PA1681543Medicaid