Provider Demographics
NPI:1770780504
Name:BENASSI CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:BENASSI CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FACO
Authorized Official - Phone:651-578-9191
Mailing Address - Street 1:731 BIELENBERG DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1700
Mailing Address - Country:US
Mailing Address - Phone:651-578-9191
Mailing Address - Fax:651-702-7499
Practice Address - Street 1:731 BIELENBERG DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:651-578-9191
Practice Address - Fax:651-702-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3335029OtherMN TAX ID
MN1B02B20BEOtherBCBS
MN231918OtherCHIRO CARE
MN498528100Medicaid
MN7740072OtherAETNA
MN1619954849OtherINDIVIDUAL NPI
MN02B20BEOtherBCBS
MN=========OtherFEDERAL TAX ID
MN3335029OtherMN TAX ID
MN02B20BEOtherBCBS
MN231918OtherCHIRO CARE