Healthcare Provider Details

I. General information

NPI: 1477600823
Provider Name (Legal Business Name): BENJAMIN BRONSON WOJCIAK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WILLOW CREEK RD
PRESCOTT AZ
86301-1141
US

IV. Provider business mailing address

1590 WILLOW CREEK RD
PRESCOTT AZ
86301-1141
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-1899
  • Fax:
Mailing address:
  • Phone: 928-227-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7784
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: