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General NPI Number Information
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NPI Number | 1720249485
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Entity Type | Individual
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Provider Name | CHAD A BENNIS DC
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Gender | Male
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 978 GRAVENSTEIN HWY SOUTH
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City | SEBASTOPOL
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State | CA
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Zip | 95472
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Country | US
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Telephone | 707-495-2192
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Fax | 866-822-4613
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Provider Business Mailing Address
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Address Line | 978 GRAVENSTEIN HWY
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City | SEBASTOPOL
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State | CA
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Zip | 95472
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Country | US
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Telephone | 707-495-2192
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Fax | 866-822-4613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1107
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR0007015
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 33705
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5662
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License Number State | OR
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