1598066086 NPI number — AGADA CHIROPRACTIC AND INTEGRATIVE HEALTH CENTER, LLC

Table of content: DR. JOSE BATO BENIGNO JR. M.D. (NPI 1881784643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598066086 NPI number — AGADA CHIROPRACTIC AND INTEGRATIVE HEALTH CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGADA CHIROPRACTIC AND INTEGRATIVE HEALTH CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1598066086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3311 COUNTY ROAD 101 S
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
WAYZATA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55391-2866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-405-6263
Provider Business Mailing Address Fax Number:
952-406-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 COUNTY ROAD 101 S
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WAYZATA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55391-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-405-6263
Provider Business Practice Location Address Fax Number:
952-406-8060
Provider Enumeration Date:
11/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CIOLA
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
CHIROPRACTOR, OWNER
Authorized Official Telephone Number:
952-405-6263

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4542 , 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)





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