Provider Demographics
NPI:1992806673
Name:MAPLEWOOD WHITE BEAR CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MAPLEWOOD WHITE BEAR CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-770-8091
Mailing Address - Street 1:2055 WHITE BEAR AVE N STE 140
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3719
Mailing Address - Country:US
Mailing Address - Phone:651-770-8091
Mailing Address - Fax:
Practice Address - Street 1:2055 WHITE BEAR AVE N STE 140
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-3719
Practice Address - Country:US
Practice Address - Phone:651-770-8091
Practice Address - Fax:651-770-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN4352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002837Medicare ID - Type Unspecified
MNU94468Medicare UPIN