Provider Demographics
NPI:1164771424
Name:BENNETT FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BENNETT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-793-7147
Mailing Address - Street 1:950 YALE AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1858
Mailing Address - Country:US
Mailing Address - Phone:203-793-7147
Mailing Address - Fax:203-793-7214
Practice Address - Street 1:950 YALE AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1858
Practice Address - Country:US
Practice Address - Phone:203-793-7147
Practice Address - Fax:203-793-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001858261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center