Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1779 | NE |
N | 111NI0013X | Independent Medical Examiner | 3435763523 | NE |
NPI | 1144643875 |
---|---|
Provider Name | Dr. Cody Jon Benson |
First Address | Grand Island, NE 68803-9117 |
Second Address | Grand Island, NE 68803-9117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 31/01/2014 |