Healthcare Provider Details

I. General information

NPI: 1457687253
Provider Name (Legal Business Name): BENJAMIN J PONTIUS D.C, M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35060 KENAI SPUR HWY SUITE 1
SOLDOTNA AK
99669-7621
US

IV. Provider business mailing address

35060 KENAI SPUR HWY SUITE 1
SOLDOTNA AK
99669-7620
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-4949
  • Fax: 907-420-4950
Mailing address:
  • Phone: 907-420-4949
  • Fax: 907-420-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number499
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: