Provider Demographics
NPI:1124285622
Name:BENNINGTON, SEAN RAY (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:RAY
Last Name:BENNINGTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11542 W. 95TH ST.
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214
Mailing Address - Country:US
Mailing Address - Phone:913-284-6769
Mailing Address - Fax:
Practice Address - Street 1:11542 W. 95TH ST.
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-284-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2023-08-23
Deactivation Date:2020-08-03
Deactivation Code:
Reactivation Date:2023-08-23
Provider Licenses
StateLicense IDTaxonomies
KST01901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS41480018OtherBLUE CROSS BLUE SHIELD