Provider Demographics
NPI:1841255650
Name:BENEDETTO, RAYMOND J (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:BENEDETTO
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 1:623 W UNION BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3708
Mailing Address - Country:US
Mailing Address - Phone:610-974-9911
Mailing Address - Fax:610-974-9988
Practice Address - Street 1:623 W UNION BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3708
Practice Address - Country:US
Practice Address - Phone:610-974-9911
Practice Address - Fax:610-974-9988
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000240543001OtherUNITED HEALTH CARE
PABE1578027OtherHIGHMARK BLUE SHIELD
PA2258662000OtherINDEPENDENCE BLUE CROSS
PA100898290-0001Medicaid
PA1048579OtherASH
PA100898290-0001Medicaid
PAU98454Medicare UPIN