Provider Demographics
NPI:1902110919
Name:BENNETT, STEPHANIE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 YALE AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1858
Mailing Address - Country:US
Mailing Address - Phone:203-793-7147
Mailing Address - Fax:203-793-7214
Practice Address - Street 1:950 YALE AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1858
Practice Address - Country:US
Practice Address - Phone:203-793-7147
Practice Address - Fax:203-793-7214
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor