Provider Demographics
NPI:1508859182
Name:BENEVENTO, DAVID ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:BENEVENTO
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 1:2545 E BIDWELL ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6440
Mailing Address - Country:US
Mailing Address - Phone:916-983-7664
Mailing Address - Fax:
Practice Address - Street 1:2545 E BIDWELL ST
Practice Address - Street 2:SUITE 130
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6440
Practice Address - Country:US
Practice Address - Phone:916-983-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:2006-04-18
Deactivation Code:
Reactivation Date:2006-04-19
Provider Licenses
StateLicense IDTaxonomies
CA14310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0143100Medicare ID - Type Unspecified