Healthcare Provider Details

I. General information

NPI: 1790825149
Provider Name (Legal Business Name): CHRISTOPHER DALE BENNETT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 SOUTH MALL ROAD
KNOXVILLE TN
37917
US

IV. Provider business mailing address

PO BOX 3187
KNOXVILLE TN
37927-3187
US

V. Phone/Fax

Practice location:
  • Phone: 865-566-0160
  • Fax: 865-544-1718
Mailing address:
  • Phone: 865-566-0160
  • Fax: 865-544-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC0000001127
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: