Healthcare Provider Details

I. General information

NPI: 1396880753
Provider Name (Legal Business Name): BENJAMIN SETH BUELTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BENJAMIN SETH BUELTER D.C.

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 N KNOXVILLE AVE SUITE D
PEORIA IL
61614-6086
US

IV. Provider business mailing address

4410 N KNOXVILLE AVE SUITE D
PEORIA IL
61614-6086
US

V. Phone/Fax

Practice location:
  • Phone: 309-282-6419
  • Fax: 309-282-6003
Mailing address:
  • Phone: 309-282-6419
  • Fax: 309-282-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-005718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: