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Organization
JACKSONVILLE CHIROPRACTIC P. A.
Active
Organization
JACKSONVILLE CHIROPRACTIC P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE W BENNETT D.C. (OWNER)
(501) 985-7711
Entity
Organization
Contact information
Practice address
1727 T P WHITE DR, JACKSONVILLE, AR 72076-2861
(501) 985-7711
(501) 985-8385
Mailing address
1727 T P WHITE DR, JACKSONVILLE, AR 72076-2861
(501) 985-7711
(501) 985-8385
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F994
MEDICARE GROUP PTAN
AR
01
—
5T401
MEDICARE GROUP MEMBER PTAN
AR
01
—
U63233
UPIN
AR
Enumeration date
11/08/2007
Last updated
08/05/2008
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