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Individual
DR. TRUDY L BENNETT
Active
Individual
DR. TRUDY L BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1435
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136565718
—
AR
01
—
19689000000
QUAL CHOICE
AR
01
—
5C748
BCBS GROUP ID#
AR
01
—
5T449
BCBS PROVIDER ID#
AR
01
—
7483095
AETNA
AR
01
—
P00613713
RR MEDICARE-PALMETTO
AR
Enumeration date
07/11/2006
Last updated
08/05/2013
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