Provider Demographics
NPI:1093980773
Name:BENO CLINIC CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:BENO CLINIC CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-347-4445
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-0479
Mailing Address - Country:US
Mailing Address - Phone:231-347-4445
Mailing Address - Fax:231-347-1957
Practice Address - Street 1:8983 M-119
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-347-4445
Practice Address - Fax:231-347-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32725Medicare PIN
MIOB45003Medicare UPIN