MEDICARE: BENAWAY CHIROPRACTIC, LLC

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

General Provider Information

NPI Number	:	1659103950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENAWAY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	2629 VINEYARD LN
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8915
Country	:	US
Telephone Number	:	989-708-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 BROOKLYN RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-9227
Country	:	US
Telephone Number	:	989-708-7255
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARRETT BENAWAY
Credential	:	DC
Telephone Number	:	989-708-7255

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/25/2024

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