MEDICARE: BENNA MARGUARITA CLICK 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	111N00000X	Chiropractor	DC009728	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C12054099	OTHER	PA	BCBS
2	1720318207	OTHER	PA	GROUP NPI
3	908757	OTHER	PA	HEALTH AMERICA/HEALTH ASSURANCE
4	412541	OTHER	PA	UPMC
5	724922	OTHER	PA	UNITED

General Provider Information

NPI Number	:	1548443641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNA MARGUARITA CLICK D.C.

Provider Business Mailing Address
First Line	:	220 N BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1638
Country	:	US
Telephone Number	:	724-264-4667
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 N BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1638
Country	:	US
Telephone Number	:	724-264-4667
Fax Number	:

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

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	08/12/2010

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