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General NPI Number Information
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NPI Number | 1508841107
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Entity Type | Organization
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Legal Business Name | WAYNE A BENNETT
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1202 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1400
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Country | US
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Telephone | 928-771-9400
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Fax | 928-771-9464
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Provider Business Mailing Address
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Address Line | 1202 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1400
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Country | US
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Telephone | 928-771-9400
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Fax | 928-771-9464
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAYNE BENNETT
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Credential | D.C.,D.A.B.C.O.
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Telephone | 928-771-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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