Provider Demographics
NPI:1619954849
Name:BENASSI, GINA M (DC, FACO,)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:BENASSI
Suffix:
Gender:F
Credentials:DC, FACO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BIELENBERG DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1700
Mailing Address - Country:US
Mailing Address - Phone:651-578-9191
Mailing Address - Fax:651-702-7499
Practice Address - Street 1:731 BIELENBERG DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55025-1700
Practice Address - Country:US
Practice Address - Phone:651-578-9191
Practice Address - Fax:651-702-7499
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
41-1883279OtherFEDERAL TAX ID
MN02B21BEOtherEPNI SELECT CHIROPRACTIC
MN0446OtherHSM PROVIDER NUMBER
MN231918OtherCHIROCARE OF MN
MN350002251OtherMEDICARE ID - TYPE UNSPECIFIED
MN350049060OtherRAILROAD MEDICARE
MN476452OtherFOCUS HEALTHCARE MGMNT
MN498528100Medicaid
MNMN3755OtherPREFERRED CHIROPRACTIC CA
MN02B20BEOtherPROVIDER #
MNU30192Medicare UPIN
41-1883279OtherFEDERAL TAX ID