Provider Demographics
NPI:1912095415
Name:BENEDETTI, ERIC SEAN (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SEAN
Last Name:BENEDETTI
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 1:567 CHURCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2011
Mailing Address - Country:US
Mailing Address - Phone:610-948-4161
Mailing Address - Fax:610-948-6487
Practice Address - Street 1:567 CHURCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2011
Practice Address - Country:US
Practice Address - Phone:610-948-4161
Practice Address - Fax:610-948-6487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005689L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA579172Medicare PIN