Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 08000901A | IN |
NPI | 1326129974 |
---|---|
Provider Name | Shawn R. Benzinger |
First Address | Indianapolis, IN 46250-2881 |
Second Address | Indianapolis, IN 46250-2881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 02/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100228170A | (05) | IN |