MEDICARE: PATRICK M BENNETT D C A CHIROPRACTIC CORPORATION

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

General Provider Information

NPI Number	:	1174812200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK M BENNETT D C A CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	4409 TUJUNGA AVE
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91602-2053
Country	:	US
Telephone Number	:	818-766-0118
Fax Number	:	818-766-0078

Provider Business Practice Location Address
First Line	:	4409 TUJUNGA AVE
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91602-2053
Country	:	US
Telephone Number	:	818-766-0118
Fax Number	:	818-766-0078

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. PATRICK MICHAEL BENNETT
Credential	:
Telephone Number	:	818-766-0118

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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