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General NPI Number Information
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NPI Number | 1528158086
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Entity Type | Individual
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Provider Name | BENJAMIN VINCENT DC
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13036 NYS RTE 9N
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City | JAY
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State | NY
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Zip | 12941
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Country | US
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Telephone | 518-946-7886
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Fax | 518-946-7367
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Provider Business Mailing Address
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Address Line | 1042 BARTLETT RD
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City | UPPER JAY
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State | NY
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Zip | 12987-3402
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Country | US
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Telephone | 518-946-2620
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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 | X010729
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License Number State | NY
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