Provider Demographics
NPI:1033279567
Name:BENNETT CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BENNETT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CULLER
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DOC
Authorized Official - Phone:843-744-6501
Mailing Address - Street 1:3901 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7042
Mailing Address - Country:US
Mailing Address - Phone:843-744-6501
Mailing Address - Fax:843-747-6858
Practice Address - Street 1:3901 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7042
Practice Address - Country:US
Practice Address - Phone:843-744-6501
Practice Address - Fax:843-747-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherBCBS