Provider Demographics
NPI:1851332985
Name:BENNETT, ALBERT BUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:BUREN
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 1:1675 HERAEUS BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3383
Mailing Address - Country:US
Mailing Address - Phone:770-271-9355
Mailing Address - Fax:770-932-1277
Practice Address - Street 1:1675 HERAEUS BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3383
Practice Address - Country:US
Practice Address - Phone:770-271-9355
Practice Address - Fax:770-932-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBKVMedicare ID - Type Unspecified