NPI Code Detail JSON Logo

1265732929 NPI number — BENJAMIN RICHARD BRODHEAD L.AC.

NPI Number: 1265732929
Health Care Provider/Practitioner: BENJAMIN RICHARD BRODHEAD L.AC.

Information about “1265732929” NPI (BENJAMIN RICHARD BRODHEAD L.AC.) exists in 1265732929 in HTML format HTML  |  1265732929 in plain Text format TXT  |  1265732929 in PDF (Portable Document Format) PDF  |  1265732929 in an XML format XML  formats.

NPI Number : 1265732929 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265732929",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRODHEAD",
    "FirstName": "BENJAMIN",
    "MiddleName": "RICHARD",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "L.AC.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRODHEAD",
    "OtherFirstName": "BEN",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "L.AC; M.AC.O.M.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "51 JOHNNY MERCER BLVD STE B2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAVANNAH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31410-4924",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "912-349-2101",
    "MailingAddressFaxNumber": "912-480-9679",
    "FirstLinePracticeLocationAddress": "51 JOHNNY MERCER BLVD STE B2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAVANNAH",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31410-4924",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-349-2101",
    "PracticeLocationAddressFaxNumber": "912-480-9679",
    "EnumerationDate": "10/28/2010",
    "LastUpdateDate": "06/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "AC60181638",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "287",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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