Provider Demographics
NPI:1487312138
Name:SCHWARTZ, BENJAMIN TODD (ND, DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TODD
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MAINLINE BLVD APT 3303
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-0511
Mailing Address - Country:US
Mailing Address - Phone:804-380-9630
Mailing Address - Fax:
Practice Address - Street 1:8832 BLAKENEY PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6731
Practice Address - Country:US
Practice Address - Phone:704-282-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor