MEDICARE: BENASSI CHIROPRACTIC, P.A.

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	2985	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3335029	OTHER	MN	MN TAX ID
2	1B02B20BE	OTHER	MN	BCBS
3	231918	OTHER	MN	CHIRO CARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7740072	OTHER	MN	AETNA
6	1619954849	OTHER	MN	INDIVIDUAL NPI
7	02B20BE	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1770780504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENASSI CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	731 BIELENBERG DR
Second Line	:	SUITE 101
City	:	WOODBURY
State	:	MN
Zip	:	55125-1700
Country	:	US
Telephone Number	:	651-578-9191
Fax Number	:	651-702-7499

Provider Business Practice Location Address
First Line	:	731 BIELENBERG DR
Second Line	:	SUITE 101
City	:	WOODBURY
State	:	MN
Zip	:	55125-1700
Country	:	US
Telephone Number	:	651-578-9191
Fax Number	:	651-702-7499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GINA M. BENASSI
Credential	:	D.C., F.A.C.O.
Telephone Number	:	651-578-9191

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	10/04/2011

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Directions to “BENASSI CHIROPRACTIC, P.A. ” Practice Location

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