Provider Demographics
NPI:1215081518
Name:BENNETT, LAWRENCE KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:KEITH
Last Name:BENNETT
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 1:705 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1824
Mailing Address - Country:US
Mailing Address - Phone:270-298-9510
Mailing Address - Fax:270-298-9395
Practice Address - Street 1:705 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1824
Practice Address - Country:US
Practice Address - Phone:270-298-9510
Practice Address - Fax:270-298-9395
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
6075801Medicare PIN