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General NPI Number Information
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NPI Number | 1073796207
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Entity Type | Organization
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Legal Business Name | BENNETT CHIROPRACTIC AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 3725 BONITA BEACH RD STE 4
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1400
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Country | US
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Telephone | 239-763-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 BONITA BEACH RD STE 4
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1400
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Country | US
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Telephone | 239-763-1288
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICOLE MICHELLE BENNETT
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Credential | DC
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Telephone | 239-763-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8675
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License Number State | FL
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