Provider Demographics
NPI:1538994660
Name:BENJAMIN, KADIZHA (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:KADIZHA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CHAUNCEY LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3504
Mailing Address - Country:US
Mailing Address - Phone:860-617-8106
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD STE 203
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4635
Practice Address - Country:US
Practice Address - Phone:516-987-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01386301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty