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General NPI Number Information
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NPI Number | 1912084591
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Entity Type | Individual
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Provider Name | DR. LARRY D BENNETT
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 130 N VILLA ST
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City | PORTERVILLE
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State | CA
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Zip | 93257-3218
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Country | US
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Telephone | 559-784-9355
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Fax | 559-784-9359
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Provider Business Mailing Address
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Address Line | 1279 W HENDERSON AVE # 338
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City | PORTERVILLE
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State | CA
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Zip | 93257-1454
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Country | US
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Telephone | 559-784-9355
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Fax | 559-784-9359
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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 | DC0291190
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License Number State | CA
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