Provider Demographics
NPI:1568469468
Name:MCCONE, BENTON DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:BENTON
Middle Name:DALE
Last Name:MCCONE
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 1:15705 35TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1487
Mailing Address - Country:US
Mailing Address - Phone:763-550-1006
Mailing Address - Fax:763-550-1008
Practice Address - Street 1:15705 35TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1487
Practice Address - Country:US
Practice Address - Phone:763-550-1006
Practice Address - Fax:763-550-1008
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor