Provider Demographics
NPI:1174622088
Name:SHULTZ, BENJAMIN JASON (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JASON
Last Name:SHULTZ
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 1:2686 MONROEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2302
Mailing Address - Country:US
Mailing Address - Phone:412-372-3772
Mailing Address - Fax:412-372-3688
Practice Address - Street 1:2686 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2302
Practice Address - Country:US
Practice Address - Phone:412-372-3772
Practice Address - Fax:412-372-3688
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ009184208100000X
PADC009299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410985OtherUPMC
PA001676326OtherBLUE SHIELD
PA001676326OtherBLUE SHIELD
PA410985OtherUPMC