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General NPI Number Information
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NPI Number | 1689030249
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Entity Type | Individual
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Provider Name | BENJAMIN DIEFFENBACHER
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Gender | Male
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 430 S DIXIE HWY STE 211
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City | CORAL GABLES
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State | FL
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Zip | 33146-2200
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Country | US
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Telephone | 786-502-2173
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Fax | 786-221-3628
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Provider Business Mailing Address
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Address Line | 13865 S DIXIE HWY SUITE 307
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City | MIAMI
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State | FL
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Zip | 33176-7221
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Country | US
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Telephone | 305-252-9090
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Fax | 305-252-9058
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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 | CH11657
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License Number State | FL
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