Provider Demographics
NPI:1831184761
Name:BENNETT, KATHRYN MARIE (DC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
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 386
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-0386
Mailing Address - Country:US
Mailing Address - Phone:434-634-3138
Mailing Address - Fax:
Practice Address - Street 1:322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-2028
Practice Address - Country:US
Practice Address - Phone:434-634-4428
Practice Address - Fax:434-634-9183
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001192111N00000X
NC3500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106208OtherANTHEM PROVIDER NUMBER
VA301459OtherANTHEM
VA301459OtherANTHEM