Provider Demographics
NPI:1790825149
Name:BENNETT, CHRISTOPHER DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DALE
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:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37927-3187
Mailing Address - Country:US
Mailing Address - Phone:865-566-0160
Mailing Address - Fax:865-544-1718
Practice Address - Street 1:3018 SOUTH MALL ROAD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-566-0160
Practice Address - Fax:865-544-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001127111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038277OtherBCBS OF TN
TNU51278Medicare UPIN
TN3677337Medicare ID - Type Unspecified