Provider Demographics
NPI:1720373186
Name:LUKE A BENNETT LLC
Entity Type:Organization
Organization Name:LUKE A BENNETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-544-6548
Mailing Address - Street 1:201 MCCULLOUGH DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3577
Mailing Address - Country:US
Mailing Address - Phone:304-544-6548
Mailing Address - Fax:
Practice Address - Street 1:201 MCCULLOUGH DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3577
Practice Address - Country:US
Practice Address - Phone:304-544-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty