MEDICARE: TINA BENNETT-BURTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10635	TX
2	111N00000X	Chiropractor	DC-10635	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	629006AR6E	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619184496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA BENNETT-BURTON D.C.

Provider Business Mailing Address
First Line	:	2700 VALLEY VIEW LN
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4925
Country	:	US
Telephone Number	:	214-718-7832
Fax Number	:	855-831-9205

Provider Business Practice Location Address
First Line	:	2700 VALLEY VIEW LN
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4925
Country	:	US
Telephone Number	:	214-718-7832
Fax Number	:	855-831-9205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/03/2024

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