1770780504 NPI number — BENASSI CHIROPRACTIC, P.A.

Table of content: (NPI 1770780504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770780504 NPI number — BENASSI CHIROPRACTIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENASSI CHIROPRACTIC, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
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:
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:
1770780504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 BIELENBERG DR
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:
55125-1700
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 DR
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:
55125-1700
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:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENASSI
Authorized Official First Name:
GINA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-578-9191

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: 3335029 . This is a "MN TAX ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1B02B20BE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 231918 . This is a "CHIRO CARE" 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: 7740072 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1619954849 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 02B20BE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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