Organization
EVERGREEN PAIN MANAGEMENT & REHABILITATION LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN L BENNETT D.C. (OWNER)
(440) 240-9111
Entity
Organization
Contact information
Practice address
5445 DETROIT RD, SUITE 201, SHEFFIELD VILLAGE, OH 44054-2904
(440) 240-9111
(440) 934-5459
Mailing address
5445 DETROIT RD, SUITE 201, SHEFFIELD VILLAGE, OH 44054-2904
(440) 240-9111
(440) 934-5459
Taxonomy
Speciality
Code
Description
License number
State
111NX0100X
Occupational Health Chiropractor
Primary
2954
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324155
BCBS
OH
01
—
123236700
FEDERAL WORKER'S COMPENSATION
OH
05
—
2085032
—
OH
Enumeration date
02/18/2009
Last updated
06/21/2018
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