Provider Demographics
NPI:1831329374
Name:DR. TIM A. BENNING, CHIROPRACTOR
Entity type:Organization
Organization Name:DR. TIM A. BENNING, CHIROPRACTOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-584-9067
Mailing Address - Street 1:22736 S ROCHFORD RD
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-6006
Mailing Address - Country:US
Mailing Address - Phone:605-584-9067
Mailing Address - Fax:605-584-9067
Practice Address - Street 1:22736 S ROCHFORD RD
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-6006
Practice Address - Country:US
Practice Address - Phone:605-584-9067
Practice Address - Fax:605-584-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD856261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty