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General NPI Number Information
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NPI Number | 1114657053
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Entity Type | Individual
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Provider Name | BENJAMIN JOSEPH DEGENHARDT DC
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Gender | Male
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1565 THOMAS CENTER DR
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City | EAGAN
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State | MN
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Zip | 55122-2642
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Country | US
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Telephone | 651-734-6959
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 QUARRY RD APT 443
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City | EAGAN
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State | MN
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Zip | 55121-3532
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Country | US
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Telephone | 608-769-1386
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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 | 6986
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License Number State | MN
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