Individual
BENJAMIN ROBERT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1200 1ST AVE E, SUITE C, SPENCER, IA 51301-4342
(712) 262-7511
Mailing address
503 E 18TH ST, APT 4, SPENCER, IA 51301-4659
(319) 215-0656
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000831
IA
Other
Enumeration date
12/04/2013
Last updated
12/04/2013
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