Individual
BENJAMIN DAVIS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
14395 GREENWELL SPRINGS RD STE A, GREENWELL SPRINGS, LA 70739-3340
(225) 570-8404
(225) 570-8406
Mailing address
19850 OLD SCENIC HWY STE 400, ZACHARY, LA 70791-7384
(225) 570-8404
(225) 570-8406
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1868
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1868
STATE LICENSE
LA
Enumeration date
05/24/2019
Last updated
05/24/2019
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