Healthcare Provider Details

I. General information

NPI: 1619428166
Provider Name (Legal Business Name): BENJAMIN ANDREWS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 NW GRAND BLVD
OKLAHOMA CITY OK
73116-3019
US

IV. Provider business mailing address

9904 WINDING RIDGE DR
DALLAS TX
75238-1460
US

V. Phone/Fax

Practice location:
  • Phone: 907-538-7649
  • Fax:
Mailing address:
  • Phone: 907-538-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number114814
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4351
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number15520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: