MEDICARE: MISS DANA MARIE BENASSI 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	4352	MN
2	171100000X	Acupuncturist	670	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20552BE	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972509248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DANA MARIE BENASSI D.C.

Provider Business Mailing Address
First Line	:	2580 WHITE BEAR AVE N
Second Line	:	STE 100
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5166
Country	:	US
Telephone Number	:	651-770-8091
Fax Number	:	651-770-8781

Provider Business Practice Location Address
First Line	:	2580 WHITE BEAR AVE N
Second Line	:	STE 100
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5166
Country	:	US
Telephone Number	:	651-770-8091
Fax Number	:	651-770-8781

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/11/2025

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