Provider Demographics
NPI:1093770695
Name:BENNESE, MICHAEL GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:BENNESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025
Mailing Address - Country:US
Mailing Address - Phone:717-732-2222
Mailing Address - Fax:717-732-9811
Practice Address - Street 1:30 EAST SHADY LANE
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025
Practice Address - Country:US
Practice Address - Phone:717-732-2222
Practice Address - Fax:717-732-9811
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008015L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001314434OtherHIGHMARK B. S.
PA02978500OtherCAPITAL BLUE CROSS
PA1035099OtherASHN
PA1035099OtherASHN
PA350053226Medicare ID - Type UnspecifiedPALMETTO
PAU87465Medicare UPIN