Provider Demographics
NPI:1548443641
Name:CLICK, BENNA MARGUARITA (DC)
Entity type:Individual
Prefix:
First Name:BENNA
Middle Name:MARGUARITA
Last Name:CLICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1638
Mailing Address - Country:US
Mailing Address - Phone:724-264-4667
Mailing Address - Fax:
Practice Address - Street 1:220 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1638
Practice Address - Country:US
Practice Address - Phone:724-264-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC12054099OtherBCBS
PA1720318207OtherGROUP NPI
PA908757OtherHEALTH AMERICA/HEALTH ASSURANCE
PA412541OtherUPMC
PA724922OtherUNITED
PA724922OtherUNITED
PA908757OtherHEALTH AMERICA/HEALTH ASSURANCE