Provider Demographics
NPI:1053736371
Name:BENNINGTON CHIROPRACTIC
Entity type:Organization
Organization Name:BENNINGTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR//OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-847-2225
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:74723-0302
Mailing Address - Country:US
Mailing Address - Phone:580-847-2225
Mailing Address - Fax:
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOKCHITO
Practice Address - State:OK
Practice Address - Zip Code:74726-1127
Practice Address - Country:US
Practice Address - Phone:580-847-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3973261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center