10D2062802 CLIA NUMBER - BENNETT CHIROPRACTIC CLINIC INC

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Laboratory Demographics

CLIA Number: 10D2062802

Facility Name: BENNETT CHIROPRACTIC CLINIC INC

Facility Address:
3945 S NOVA RD
PORT ORANGE, FL
ZIP 32127
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Facility Phone Number: 386 767-1100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346351244

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	10D2062802
LAB Type	Physician Office
Facility Name	BENNETT CHIROPRACTIC CLINIC INC
Street	3945 S NOVA RD
City	PORT ORANGE
State	FL
ZIP	32127
Phone	386 767-1100
CertificateType	4
CertificateEffectiveDate	7/23/2023
CertificateExpirationDate	7/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024