MEDICARE: DR. DAVID JOHN 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	CH5632	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22097	OTHER		BC BS

General Provider Information

NPI Number	:	1982784724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOHN BENNETT DC

Provider Business Mailing Address
First Line	:	PO BOX 160546
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-0546
Country	:	US
Telephone Number	:	407-660-1200
Fax Number	:	407-682-2534

Provider Business Practice Location Address
First Line	:	1002 WEST S R 436
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714
Country	:	US
Telephone Number	:	407-660-1200
Fax Number	:	407-682-2534

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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