Provider Demographics
NPI:1063611283
Name:BENTLEY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:BENTLEY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-893-0231
Mailing Address - Street 1:123 E WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3349
Mailing Address - Country:US
Mailing Address - Phone:419-893-0231
Mailing Address - Fax:419-891-6900
Practice Address - Street 1:123 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3349
Practice Address - Country:US
Practice Address - Phone:419-893-0231
Practice Address - Fax:419-891-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0786556Medicaid
OH0786556Medicaid