Provider Demographics
NPI:1740587310
Name:BENNETT, DANIEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
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 1:15 JANE JACOBS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6306
Mailing Address - Country:US
Mailing Address - Phone:828-664-1600
Mailing Address - Fax:828-664-1601
Practice Address - Street 1:15 JANE JACOBS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6306
Practice Address - Country:US
Practice Address - Phone:828-664-1600
Practice Address - Fax:828-664-1601
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917110Medicaid
NC5917110Medicaid