Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1704 | MA |
NPI | 1003973058 |
---|---|
Provider Name | Dr. John Paul Beneski |
First Address | Boston, MA 02109-4806 |
Second Address | Boston, MA 02109-4806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1611011 | (05) | MA |
35485 | HPHC (01) | MA |
U33490 | (02) | MA |