Provider Demographics
NPI:1619184496
Name:BENNETT-BURTON, TINA (DC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BENNETT-BURTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:MICHELLE
Other - Last Name:ARIKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10 MEDICAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7845
Mailing Address - Country:US
Mailing Address - Phone:214-718-7832
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7845
Practice Address - Country:US
Practice Address - Phone:214-718-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10635111N00000X
TXDC-10635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX629006AR6EOtherMEDICARE
TX3808651-01Medicaid