MEDICARE: MARK THOMAS BENNETT D.C.

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	DC24284	CA

General Provider Information

NPI Number	:	1255327623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK THOMAS BENNETT D.C.

Provider Business Mailing Address
First Line	:	5031 E ORANGETHORPE AVE
Second Line	:	SUITE H
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1131
Country	:	US
Telephone Number	:	714-779-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	5031 E ORANGETHORPE AVE
Second Line	:	SUITE H
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1131
Country	:	US
Telephone Number	:	714-779-7979
Fax Number	:

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/08/2007

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