MEDICARE: DR. BENTON MCCONE 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	4099	MN

General Provider Information

NPI Number	:	1811206683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. BENTON MCCONE P.A.

Provider Business Mailing Address
First Line	:	15705 35TH AVE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15705 35TH AVE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1487
Country	:	US
Telephone Number	:	763-550-1006
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. BENTON DALE MCCONE
Credential	:
Telephone Number	:	763-550-1006

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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