MEDICARE: JEREMY BENZ SUCCOP DC

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	111N00000X	Chiropractor	DC009354	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0016689	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1356408793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY BENZ SUCCOP DC

Provider Business Mailing Address
First Line	:	3424 WILLIAM PENN HWY
Second Line	:	SUITE 168
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5444
Country	:	US
Telephone Number	:	412-823-2180
Fax Number	:	412-823-6165

Provider Business Practice Location Address
First Line	:	3424 WILLIAM PENN HWY
Second Line	:	SUITE 168
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5444
Country	:	US
Telephone Number	:	412-823-2180
Fax Number	:	412-823-6165

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/30/2012

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Directions to “ JEREMY BENZ SUCCOP DC” Practice Location

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