Provider Demographics
NPI:1710162854
Name:BENNETT CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BENNETT CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-774-7189
Mailing Address - Street 1:120 W DUBLIN DR
Mailing Address - Street 2:102
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3155
Mailing Address - Country:US
Mailing Address - Phone:256-774-7189
Mailing Address - Fax:
Practice Address - Street 1:120 W DUBLIN DR
Practice Address - Street 2:102
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3155
Practice Address - Country:US
Practice Address - Phone:256-774-7189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51507154OtherBLUE CROSS/BLUE SHEILD
AL51507154OtherBLUE CROSS/BLUE SHEILD