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General NPI Number Information
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NPI Number | 1609054816
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Entity Type | Individual
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Provider Name | LAJA'VIA KRENELE BENJAMIN D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 4600 W COMMERCIAL BLVD STE 5
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City | TAMARAC
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State | FL
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Zip | 33319-3307
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Country | US
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Telephone | 954-541-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 545 NE 66TH ST
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City | MIAMI
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State | FL
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Zip | 33138-5618
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Country | US
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Telephone | 404-932-1324
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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 | CH9150
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH9150
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License Number State | FL
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