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General NPI Number Information
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NPI Number | 1205171949
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Entity Type | Organization
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Legal Business Name | S ALLEN BENNION DC LTD
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 3801 N 15TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015
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Country | US
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Telephone | 480-208-2892
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 N 15TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-5545
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Country | US
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Telephone | 480-208-2892
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | S ALLEN BENNION
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Credential | DC
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Telephone | 480-208-2892
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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 | DC703
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License Number State | AZ
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