Provider Demographics
NPI:1346540283
Name:BENNETT CHIROPRACTIC NORTHDALE PA
Entity Type:Organization
Organization Name:BENNETT CHIROPRACTIC NORTHDALE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-341-7227
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:SUITE 100W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-341-7227
Mailing Address - Fax:813-341-7250
Practice Address - Street 1:3903 NORTHDALE BLVD
Practice Address - Street 2:SUITE 100W
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1864
Practice Address - Country:US
Practice Address - Phone:813-341-7227
Practice Address - Fax:813-341-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9954111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89036Medicare PIN