=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003985722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNINGFIELD FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 11/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2785 CHARLOTTE HWY 21 SUITE 23
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-9510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-799-8060
-----------------------------------------------------
Fax | 704-799-8131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2785 CHARLOTTE HWY 21 SUITE 23
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-9510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-799-8060
-----------------------------------------------------
Fax | 704-799-8131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT SCOTT BENNINGFIELD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 704-799-8060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------