Provider Demographics
NPI:1114310984
Name:BENNETT CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:BENNETT CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-737-9500
Mailing Address - Street 1:909 GRAHAM ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5237
Mailing Address - Country:US
Mailing Address - Phone:256-737-9500
Mailing Address - Fax:
Practice Address - Street 1:909 GRAHAM ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5237
Practice Address - Country:US
Practice Address - Phone:256-737-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-60634OtherBLUE CROSS BLUE SHIELD
AL511-60634OtherBLUE CROSS BLUE SHIELD
AL051557654Medicare PIN