Provider Demographics
NPI:1790850287
Name:BENNETTS, WILLIAM MATHEW (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATHEW
Last Name:BENNETTS
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 1:206 1/2 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-5204
Mailing Address - Country:US
Mailing Address - Phone:620-308-5151
Mailing Address - Fax:620-308-1094
Practice Address - Street 1:206 1/2 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-5204
Practice Address - Country:US
Practice Address - Phone:620-308-5151
Practice Address - Fax:620-308-1094
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05618111N00000X
MIWB009411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDV11396Medicare UPIN
MIOM49230007Medicare PIN