Healthcare Provider Details

I. General information

NPI: 1326838228
Provider Name (Legal Business Name): DR. BENJAMIN FARCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 A1A S STE A1
ST AUGUSTINE FL
32080-6374
US

IV. Provider business mailing address

2225 A1A S STE A1
ST AUGUSTINE FL
32080-6374
US

V. Phone/Fax

Practice location:
  • Phone: 904-481-8953
  • Fax:
Mailing address:
  • Phone: 904-481-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: