Healthcare Provider Details

I. General information

NPI: 1083335699
Provider Name (Legal Business Name): BENJAMIN RICHARD DINOBILE DC, MSACN, BR, CIDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 W 32ND AVE
WHEAT RIDGE CO
80033-5254
US

IV. Provider business mailing address

12505 W 32ND AVE
WHEAT RIDGE CO
80033-5254
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-9617
  • Fax:
Mailing address:
  • Phone: 303-237-9617
  • Fax: 720-419-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0008469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: