Provider Demographics
NPI:1174602577
Name:BENIZZI, DIANE (DC,)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:BENIZZI
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 1:2112 BIENVILLE BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-447-3200
Mailing Address - Fax:228-447-3201
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:STE J
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-447-3200
Practice Address - Fax:228-447-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1281111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU75789Medicare UPIN