Body Tech Sports & Rehab

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

BODY TECH SPORTS & REHAB

Practice address

1234 W Chapman Ave
Suite 204
Orange, CA 92868-2862

Phone

(714) 308-5087

Fax

(714) 289-4698

NPI assigned

Jan 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark William Bennallack, D.C., CCRNNPI 1699842385

Title

Owner

Phone

(714) 308-5087

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark William Bennallack, D.C.

  • Chiropractor
  • Orange, CA
  • NPI 1699842385
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1972654887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20252",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927280252",
            "telephone_number": "714-308-5087",
            "fax_number": "714-289-4698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 W CHAPMAN AVE",
            "address_2": "SUITE 204",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682862",
            "telephone_number": "714-308-5087",
            "fax_number": "714-289-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY TECH SPORTS & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "BENNALLACK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-308-5087",
        "authorized_official_credential": "D.C., CCRN"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen E Bocian, MD
• Daniel Hossam Boctor
• Rafik Ramy Riad Rizk Boctor, RPH
• Lakesha Sharie Bodiford
• Lisa Bodmer
• Joan M Boesel, DPT
• Katherine Bogaard
• Ella Bohorquez
• Bohrdom LLC
• Benjamin C.R. Bohrer, MBA

• Chiropractor in Orange, CA
• Providers in Orange, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.