Provider Demographics
NPI:1295827632
Name:BENESTAD, SVEIN GUNNAR (CHIROPRACTOR DC)
Entity Type:Individual
Prefix:DR
First Name:SVEIN
Middle Name:GUNNAR
Last Name:BENESTAD
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31166 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4277
Mailing Address - Country:US
Mailing Address - Phone:248-477-6400
Mailing Address - Fax:248-477-6544
Practice Address - Street 1:31166 GRAND RIVER
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-477-6400
Practice Address - Fax:248-477-6544
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35211DOtherBCBS
MIOF352110OtherBCN
MIOF352110OtherBCN
V05846Medicare UPIN