Provider Demographics
NPI:1306804760
Name:BENDER, DEAN A (MA DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:BENDER
Suffix:
Gender:M
Credentials:MA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1919
Mailing Address - Country:US
Mailing Address - Phone:269-381-0737
Mailing Address - Fax:269-381-5120
Practice Address - Street 1:611 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1919
Practice Address - Country:US
Practice Address - Phone:269-381-0737
Practice Address - Fax:269-381-5120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB004609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
649416OtherACN
0C95037Medicare ID - Type Unspecified
T32962Medicare UPIN