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Individual

DAVID BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1835 NEWPORT BLVD, #A109-161, COSTA MESA, CA 92627-5031
(949) 548-1976
Mailing address
1835 NEWPORT BLVD, #A109-161, COSTA MESA, CA 92627-5031
(949) 548-1976

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC21238
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DC21238
CHIROPRACTIC LICENSE
CA
Enumeration date
03/06/2007
Last updated
07/08/2007
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