Provider Demographics
NPI:1710384060
Name:ANDERSON, BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6278 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2527
Mailing Address - Country:US
Mailing Address - Phone:414-327-6400
Mailing Address - Fax:414-327-1215
Practice Address - Street 1:6278 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2527
Practice Address - Country:US
Practice Address - Phone:414-327-6400
Practice Address - Fax:414-327-1215
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5057-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor