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General NPI Number Information
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NPI Number | 1821774464
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Entity Type | Individual
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Provider Name | DR. BRIAN BENNETT
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 322 N CODY RD
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City | LE CLAIRE
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State | IA
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Zip | 52753-9220
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Country | US
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Telephone | 563-635-6057
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Fax |
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Provider Business Mailing Address
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Address Line | 3417 214TH ST N
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City | PORT BYRON
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State | IL
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Zip | 61275-9658
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Country | US
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Telephone | 563-676-3156
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Fax |
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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 | 121214
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License Number State | IA
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