1619954849 NPI number — DR. GINA M BENASSI DC, FACO,

Table of content: DR. GINA M BENASSI DC, FACO, (NPI 1619954849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619954849 NPI number — DR. GINA M BENASSI DC, FACO,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENASSI
Provider First Name:
GINA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, FACO,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619954849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 BIELENBERG DRIVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55025-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-578-9191
Provider Business Mailing Address Fax Number:
651-702-7499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 BIELENBERG DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55025-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-578-9191
Provider Business Practice Location Address Fax Number:
651-702-7499
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2985 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41-1883279 . This is a "FEDERAL TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02B21BE . This is a "EPNI SELECT CHIROPRACTIC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0446 . This is a "HSM PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 231918 . This is a "CHIROCARE OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 350002251 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 350049060 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 476452 . This is a "FOCUS HEALTHCARE MGMNT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 498528100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MN3755 . This is a "PREFERRED CHIROPRACTIC CA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 02B20BE . This is a "PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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