Provider Demographics
NPI:1982781365
Name:BENNER, RONALD JAMES JR (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:BENNER
Suffix:JR
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 1:381 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-6700
Mailing Address - Fax:518-587-7065
Practice Address - Street 1:381 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-6700
Practice Address - Fax:518-587-7065
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010555-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX010555-1OtherNY CHIROPRACTIC LICENSE #
NYC10555-3BOtherNYS WORKER COMP #
NY141698177OtherTAX ID NUMBER
NY350056805Medicare ID - Type Unspecified