Organization
BODY TECH SPORTS & REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WILLIAM BENNALLACK D.C., CCRN (OWNER)
(714) 308-5087
Entity
Organization
Contact information
Practice address
1234 W CHAPMAN AVE, SUITE 204, ORANGE, CA 92868-2862
(714) 308-5087
(714) 289-4698
Mailing address
PO BOX 20252, FOUNTAIN VALLEY, CA 92728-0252
(714) 308-5087
(714) 289-4698
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
111NR0400X
Rehabilitation Chiropractor
—
—
Other
Enumeration date
01/16/2007
Last updated
06/24/2008
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