Provider Demographics
NPI:1992762850
Name:BENNETT, BOBBIE (DC)
Entity type:Individual
Prefix:DR
First Name:BOBBIE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2547
Mailing Address - Country:US
Mailing Address - Phone:936-258-2789
Mailing Address - Fax:936-258-8535
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2547
Practice Address - Country:US
Practice Address - Phone:936-258-2789
Practice Address - Fax:936-258-8535
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU62586Medicare UPIN
TX605513Medicare PIN