Basic Information
| Provider Information | |||||||||
| NPI: | 1174767768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENKO | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034837778 | ||||||||
| FaxNumber: | 2034810234 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034837778 | ||||||||
| FaxNumber: | 2034810234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 02/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 001519 | CT | Y | Chiropractic Providers | Chiropractor |
No ID Information.