Provider Demographics
NPI:1154429744
Name:BENNINGFIELD & ASSOCIATES, LLC
Entity type:Organization
Organization Name:BENNINGFIELD & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-692-6800
Mailing Address - Street 1:1524 W GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4692
Mailing Address - Country:US
Mailing Address - Phone:309-692-6800
Mailing Address - Fax:309-692-4478
Practice Address - Street 1:1524 W GLEN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4692
Practice Address - Country:US
Practice Address - Phone:309-692-6800
Practice Address - Fax:309-692-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL559370Medicare ID - Type Unspecified