Organization
BENNETT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE A BENNETT D.C. (OWNER/MANAGER)
(928) 772-7200
Entity
Organization
Contact information
Practice address
7876 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-2216
(928) 772-7200
(928) 772-7779
Mailing address
7876 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-2216
(928) 772-7200
(928) 772-7779
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
20636829-L
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z139537
MEDICARE PTAN
AZ
Enumeration date
04/04/2011
Last updated
04/04/2011
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