Provider Demographics
NPI:1760413488
Name:BENNETT, GEORGE T (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
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 1:2193 RIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3729
Mailing Address - Country:US
Mailing Address - Phone:856-786-2222
Mailing Address - Fax:856-786-3663
Practice Address - Street 1:2193 RIVERTON RD
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3729
Practice Address - Country:US
Practice Address - Phone:856-786-2222
Practice Address - Fax:856-786-3663
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBE452892Medicare ID - Type UnspecifiedMEDICARE ID