Provider Demographics
NPI:1093751307
Name:BENNETT, BARBARA (DC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BENNETT
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 1:4653 S LAKESHORE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7161
Mailing Address - Country:US
Mailing Address - Phone:480-775-2593
Mailing Address - Fax:480-621-5485
Practice Address - Street 1:4653 S LAKESHORE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7161
Practice Address - Country:US
Practice Address - Phone:480-775-2593
Practice Address - Fax:480-621-5485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119639Medicare UPIN