Jordan Daniel Benton, DC | |
113 W 5th St, Eureka, MO 63025-1109 | |
(636) 938-9310 | |
(636) 938-3204 |
Full Name | Jordan Daniel Benton |
---|---|
Gender | Male |
Speciality | Chiropractor |
Location | 113 W 5th St, Eureka, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1457053738 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 2023001247 (Missouri) | Primary |
Provider Name | Comprehensive Chiropractic Pc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1740253038 PECOS PAC ID: 2769458306 Enrollment ID: O20040907000141 |
Mailing Address | Practice Location Address |
---|---|
Jordan Daniel Benton, DC 113 W 5th St, Eureka, MO 63025-1109 Ph: (636) 938-9310 | Jordan Daniel Benton, DC 113 W 5th St, Eureka, MO 63025-1109 Ph: (636) 938-9310 |
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