Provider Demographics
NPI:1699856658
Name:BENKO, JOAN ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:BENKO
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 1:3697 FREMANTLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3070
Mailing Address - Country:US
Mailing Address - Phone:727-791-9639
Mailing Address - Fax:
Practice Address - Street 1:132 10TH AVE N
Practice Address - Street 2:#105
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3407
Practice Address - Country:US
Practice Address - Phone:727-791-9639
Practice Address - Fax:727-738-6187
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70917Medicare ID - Type Unspecified