Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 13039 | TX |
NPI | 1225409626 |
---|---|
Provider Name | Dr. Donta Sherrell Bennett |
First Address | Garland, TX 75041-2634 |
Second Address | Duncanville, TX 75137-2620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2015 |
Last Update Date | 12/10/2015 |