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General NPI Number Information
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NPI Number | 1750701124
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Entity Type | Individual
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Provider Name | BENJAMIN HERRON DC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 170 S 2ND ST STE 205
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City | COOS BAY
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State | OR
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Zip | 97420-1673
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Country | US
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Telephone | 541-290-8696
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Fax | 541-808-2362
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Provider Business Mailing Address
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Address Line | 170 S 2ND ST STE 205
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City | COOS BAY
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State | OR
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Zip | 97420-1673
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Country | US
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Telephone | 541-290-8696
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Fax | 541-808-2362
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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 | 4430
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License Number State | OH
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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 | 5122
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License Number State | OR
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