Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 30803 | CA |
NPI | 1003087628 |
---|---|
Provider Name | Dr. Steven Phillip Bennett |
First Address | Solana Beach, CA 92075-1165 |
Second Address | Solana Beach, CA 92075-1165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2008 |
Last Update Date | 23/03/2008 |