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General NPI Number Information
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NPI Number | 1134315914
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Entity Type | Organization
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Legal Business Name | BENNETT CHIROPRACTIC CTR PA
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 923 GRANT ST
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City | CALDWELL
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State | ID
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Zip | 83605
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Country | US
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Telephone | 208-454-9000
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Fax | 208-454-9092
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Provider Business Mailing Address
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Address Line | 923 GRANT ST
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City | CALDWELL
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State | ID
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Zip | 83605
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Country | US
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Telephone | 208-454-9000
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Fax | 208-454-9092
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Authorized Official
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Title or Position | OWNER
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Name | KATHY R BENNETT
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Credential | DC
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Telephone | 208-454-9000
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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 | CHIA532
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License Number State |
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