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NPI Code Detail

MEDICARE: DR. JARED JOHN BENNETT D.C.

MEDICARE:  DR. JARED JOHN BENNETT  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
1111N00000XChiropractor3918OK
2111N00000XChiropractor8185842-1202UT

General Provider Information

NPI Number : 1760620371
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JARED JOHN BENNETT D.C.
Provider Business Mailing Address
First Line : 4045 NW 64TH ST STE 160
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1657
Country : US
Telephone Number : 405-659-5418
Fax Number :
Provider Business Practice Location Address
First Line : 4045 NW 64TH ST STE 160
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1657
Country : US
Telephone Number : 405-659-5418
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2009
Last Update Date : 12/28/2015

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Directions to “ DR. JARED JOHN BENNETT D.C.” Practice Location

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