Provider Demographics
NPI:1225180821
Name:COLLEGE AVENUE HEALTH ASSOCIATES PC
Entity Type:Organization
Organization Name:COLLEGE AVENUE HEALTH ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP
Authorized Official - Phone:906-786-8888
Mailing Address - Street 1:2620 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9565
Mailing Address - Country:US
Mailing Address - Phone:906-786-8888
Mailing Address - Fax:906-786-8813
Practice Address - Street 1:2620 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9565
Practice Address - Country:US
Practice Address - Phone:906-786-8888
Practice Address - Fax:906-786-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OB150120Medicare UPIN