Provider Demographics
NPI:1144368713
Name:BENNETT, MARCY LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:MARCY
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:LYNN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9961 WINGHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3623
Mailing Address - Country:US
Mailing Address - Phone:636-265-2566
Mailing Address - Fax:866-418-4148
Practice Address - Street 1:9961 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3623
Practice Address - Country:US
Practice Address - Phone:636-265-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000144756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO139154OtherBLUE CROSS BLUE SHIELD
MO38309OtherGHP CMR PROVIDER NUMBER
MO4401175OtherUNTIED HEALTHCARE PROVIDE
MO432179OtherHEALTHLINK PROVIDER NUMBE
MO4401175OtherUNTIED HEALTHCARE PROVIDE
MO432179OtherHEALTHLINK PROVIDER NUMBE