MEDICARE: DR. CHAS MICHAEL BENNETT D.C., B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009215	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063423671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAS MICHAEL BENNETT D.C., B.S.

Provider Business Mailing Address
First Line	:	8745 MIDLAND RD
Second Line	:
City	:	FREELAND
State	:	MI
Zip	:	48623-8711
Country	:	US
Telephone Number	:	770-634-3977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4604 N SAGINAW RD
Second Line	:	SUITE A
City	:	MIDLAND
State	:	MI
Zip	:	48640-2387
Country	:	US
Telephone Number	:	989-832-7535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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