Healthcare Provider Details

I. General information

NPI: 1174812200
Provider Name (Legal Business Name): PATRICK M BENNETT D C A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 TUJUNGA AVE
STUDIO CITY CA
91602-2053
US

IV. Provider business mailing address

4409 TUJUNGA AVE
STUDIO CITY CA
91602-2053
US

V. Phone/Fax

Practice location:
  • Phone: 818-766-0118
  • Fax: 818-766-0078
Mailing address:
  • Phone: 818-766-0118
  • Fax: 818-766-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK MICHAEL BENNETT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 818-766-0118