MEDICARE: DR. CARLY OVERBY BENDEWALD DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11120	TX

General Provider Information

NPI Number	:	1376720870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLY OVERBY BENDEWALD DC

Provider Business Mailing Address
First Line	:	5639 DYER ST
Second Line	:	STE 3
City	:	DALLAS
State	:	TX
Zip	:	75206-5003
Country	:	US
Telephone Number	:	214-843-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	5639 DYER ST
Second Line	:	STE 3
City	:	DALLAS
State	:	TX
Zip	:	75206-5003
Country	:	US
Telephone Number	:	214-843-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	07/11/2011

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Directions to “ DR. CARLY OVERBY BENDEWALD DC” Practice Location

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