MEDICARE: DR. DONALD RAY 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	2477	TX

General Provider Information

NPI Number	:	1457359002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD RAY BENNETT D.C.

Provider Business Mailing Address
First Line	:	PO BOX 790
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-0790
Country	:	US
Telephone Number	:	325-728-3411
Fax Number	:	325-728-3737

Provider Business Practice Location Address
First Line	:	2620 HICKORY STREET
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-0790
Country	:	US
Telephone Number	:	325-728-3411
Fax Number	:	325-728-3737

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/24/2010

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