Provider Demographics
NPI:1134265648
Name:BENNETT FAMILY CHIROPRACTIC CENTER PSC
Entity type:Organization
Organization Name:BENNETT FAMILY CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIRPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-298-9510
Mailing Address - Street 1:705 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1824
Mailing Address - Country:US
Mailing Address - Phone:270-298-9510
Mailing Address - Fax:270-298-9395
Practice Address - Street 1:705 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1824
Practice Address - Country:US
Practice Address - Phone:270-298-9510
Practice Address - Fax:270-298-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX IDENTIFICATION NUMBER