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General NPI Number Information
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NPI Number | 1104164060
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Entity Type | Individual
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Provider Name | MAGGIE RUTH BENHAM DC
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Gender | Female
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Dates
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Enumeration Date | 01/27/2013
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 23 COACH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1529
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Country | US
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Telephone | 585-394-2030
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Fax | 585-394-0454
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Provider Business Mailing Address
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Address Line | 5216 E LAKE RD
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City | RUSHVILLE
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State | NY
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Zip | 14544-9751
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Country | US
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Telephone | 585-781-4101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012305-1
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License Number State | NY
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