Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1997 | CT |
Y | 111NR0400X | Rehabilitation Chiropractor | 00-1997 | CT |
NPI | 1124410691 |
---|---|
Provider Name | Dr. Charles W Benson |
First Address | Shelton, CT 06484-6150 |
Second Address | Shelton, CT 06484-6150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2015 |
Last Update Date | 17/11/2021 |