Provider Demographics
NPI:1366618175
Name:NIXON, BENNY EDWARD II (DC)
Entity type:Individual
Prefix:DR
First Name:BENNY
Middle Name:EDWARD
Last Name:NIXON
Suffix:II
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 1:2020 W WHISPERING WIND DR
Mailing Address - Street 2:STE. 119
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2848
Mailing Address - Country:US
Mailing Address - Phone:623-889-3480
Mailing Address - Fax:623-889-3481
Practice Address - Street 1:2020 W WHISPERING WIND DR
Practice Address - Street 2:STE. 119
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2848
Practice Address - Country:US
Practice Address - Phone:623-889-3480
Practice Address - Fax:623-889-3481
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7308111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7308OtherCHIROPRACTIC LICENSE #
AZZ124252Medicare PIN