Provider Demographics
NPI:1457359002
Name:BENNETT, DONALD RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
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 790
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-0790
Mailing Address - Country:US
Mailing Address - Phone:325-728-3411
Mailing Address - Fax:325-728-3737
Practice Address - Street 1:2620 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-0790
Practice Address - Country:US
Practice Address - Phone:325-728-3411
Practice Address - Fax:325-728-3737
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600820Medicare ID - Type UnspecifiedMEDICARE/MEDICAID
TXT12171Medicare UPIN