Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 01875 | MD |
NPI | 1265558217 |
---|---|
Provider Name | Dr. Kevin F Benson |
First Address | Germantown, MD 20874-1572 |
Second Address | Rockville, MD 20852-3906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
299717 | (02) | MD |
M567-0001 | (02) | MD |
S8370001 | (02) | MH |