Healthcare Provider Details

I. General information

NPI: 1801103320
Provider Name (Legal Business Name): ROGER BENTER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N HURON ST
CHEBOYGAN MI
49721-1513
US

IV. Provider business mailing address

320 N HURON ST
CHEBOYGAN MI
49721-1513
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-4345
  • Fax: 231-627-4491
Mailing address:
  • Phone: 231-627-4345
  • Fax: 231-627-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005225
License Number StateMI

VIII. Authorized Official

Name: DR. ROGER BENTER
Title or Position: OWNER
Credential: D.C.
Phone: 231-627-4345