Provider Demographics
NPI:1215031257
Name:BENDER, JEFFREY L (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:BENDER
Suffix:
Gender:M
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:PO BOX 2927
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-2927
Mailing Address - Country:US
Mailing Address - Phone:505-865-7610
Mailing Address - Fax:505-865-8673
Practice Address - Street 1:209 HIGHWAY 314 NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6697
Practice Address - Country:US
Practice Address - Phone:505-865-7610
Practice Address - Fax:505-865-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201000668OtherPRESBYTERIAN
NM00KP19OtherBC/BS
NM00KP19OtherBC/BS