Healthcare Provider Details

I. General information

NPI: 1952311417
Provider Name (Legal Business Name): BENNITT PATTERSON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N YOUNG BLVD
CHIEFLAND FL
32626-1951
US

IV. Provider business mailing address

PO BOX 1027
CHIEFLAND FL
32644-1027
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-1540
  • Fax: 352-493-1628
Mailing address:
  • Phone: 352-493-1540
  • Fax: 352-493-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6495
License Number StateFL

VIII. Authorized Official

Name: DR. BENNITT C PATTERSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 352-493-1540