Provider Demographics
NPI:1407832801
Name:BENNETT, STEVEN FREDERICK (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FREDERICK
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5526
Mailing Address - Country:US
Mailing Address - Phone:501-374-1153
Mailing Address - Fax:501-374-6213
Practice Address - Street 1:636 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5526
Practice Address - Country:US
Practice Address - Phone:501-374-1153
Practice Address - Fax:501-374-6213
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152197718Medicaid
AR1801872304OtherGROUP NPI
AR350052757OtherRAILROAD MEDICARE ID #
AR152197718Medicaid
AR59014Medicare PIN