Provider Demographics
NPI:1679614101
Name:BENNETT, RONDLE (DC)
Entity Type:Individual
Prefix:DR
First Name:RONDLE
Middle Name:
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 1:520 E WHIDBEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2600
Mailing Address - Country:US
Mailing Address - Phone:360-682-2759
Mailing Address - Fax:360-682-2763
Practice Address - Street 1:520 E WHIDBEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2600
Practice Address - Country:US
Practice Address - Phone:360-682-2759
Practice Address - Fax:360-682-2763
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8929119Medicare PIN