Provider Demographics
NPI:1225409626
Name:BENNETT, DONTA SHERRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:DONTA
Middle Name:SHERRELL
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 1:2818 WIMBLEDON CT APT B
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2634
Mailing Address - Country:US
Mailing Address - Phone:214-335-2633
Mailing Address - Fax:469-727-7833
Practice Address - Street 1:726 S COCKRELL HILL RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2620
Practice Address - Country:US
Practice Address - Phone:469-727-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13039111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician