Provider Demographics
NPI:1811104771
Name:BENNETT, MARK ANDREW (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
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 297
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26547-0297
Mailing Address - Country:US
Mailing Address - Phone:304-864-6400
Mailing Address - Fax:304-864-5030
Practice Address - Street 1:VALLEY PLAZA RT. 7
Practice Address - Street 2:SUITE 4
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547
Practice Address - Country:US
Practice Address - Phone:304-864-6400
Practice Address - Fax:304-864-5030
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor