Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1215 | OH |
NPI | 1205905536 |
---|---|
Provider Name | Dr. Lewis Edmond Bennett II |
First Address | Hudson, OH 44236-1248 |
Second Address | Northfield, OH 44067-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 06/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0619898 | (05) | OH |
34-1513396 | (02) | OH |