Provider Demographics
NPI:1063423671
Name:BENNETT, CHAS MICHAEL (DC, BS)
Entity type:Individual
Prefix:DR
First Name:CHAS
Middle Name:MICHAEL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8711
Mailing Address - Country:US
Mailing Address - Phone:770-634-3977
Mailing Address - Fax:
Practice Address - Street 1:4604 N SAGINAW RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2387
Practice Address - Country:US
Practice Address - Phone:989-832-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4892603Medicaid