Provider Demographics
NPI:1689838484
Name:BENELLI, LYNNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:BENELLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1645 19TH ST SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-6820
Mailing Address - Country:US
Mailing Address - Phone:772-643-4400
Mailing Address - Fax:
Practice Address - Street 1:1580 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5450
Practice Address - Country:US
Practice Address - Phone:772-643-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor