MEDICARE: DR. DEAN MITCHELL BENSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC22967	CA

General Provider Information

NPI Number	:	1033321385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN MITCHELL BENSON D.C.

Provider Business Mailing Address
First Line	:	16458 BOLSA CHICA ST
Second Line	:	# 407
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2603
Country	:	US
Telephone Number	:	714-840-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	16458 BOLSA CHICA ST
Second Line	:	# 407
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2603
Country	:	US
Telephone Number	:	714-840-0920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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