Provider Demographics
NPI:1447264585
Name:BENNER, CHRISTINE DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DIANE
Last Name:BENNER
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 1:20 W 22ND ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5804
Mailing Address - Country:US
Mailing Address - Phone:212-929-2424
Mailing Address - Fax:212-929-2458
Practice Address - Street 1:20 W 22ND ST
Practice Address - Street 2:SUITE 1402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5804
Practice Address - Country:US
Practice Address - Phone:212-929-2424
Practice Address - Fax:212-929-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005811111N00000X
NY003531171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX37551Medicare ID - Type Unspecified