Provider Demographics
NPI:1518071414
Name:BENOIT, DAVID W (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:BENOIT
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 1:972 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351
Mailing Address - Country:US
Mailing Address - Phone:207-622-3900
Mailing Address - Fax:207-622-1860
Practice Address - Street 1:972 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351
Practice Address - Country:US
Practice Address - Phone:207-622-3900
Practice Address - Fax:207-622-1860
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
005156OtherANTHEM
MM2006Medicare ID - Type Unspecified