MEDICARE: DR. TRUDY L BENNETT DC

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	1435	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00613713	OTHER	AR	RR MEDICARE-PALMETTO

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
2	5T449	OTHER	AR	BCBS PROVIDER ID#
3	7483095	OTHER	AR	AETNA
4	19689000000	OTHER	AR	QUAL CHOICE
5	5C748	OTHER	AR	BCBS GROUP ID#

General Provider Information

NPI Number	:	1215962311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRUDY L BENNETT DC

Provider Business Mailing Address
First Line	:	300 S RODNEY PARHAM RD
Second Line	:	SUITE 11
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4774
Country	:	US
Telephone Number	:	501-663-4663
Fax Number	:	501-663-7689

Provider Business Practice Location Address
First Line	:	300 S RODNEY PARHAM RD
Second Line	:	SUITE 11
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4774
Country	:	US
Telephone Number	:	501-663-4663
Fax Number	:	501-663-7689

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/05/2013

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Directions to “ DR. TRUDY L BENNETT DC” Practice Location

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