Healthcare Provider Details

I. General information

NPI: 1861797342
Provider Name (Legal Business Name): JEFFREY L. BENDER, D.C., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HIGHWAY 314 NW
LOS LUNAS NM
87031-6697
US

IV. Provider business mailing address

PO BOX 2927
LOS LUNAS NM
87031-2927
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-7610
  • Fax: 505-865-8673
Mailing address:
  • Phone: 505-865-7610
  • Fax: 505-865-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1247
License Number StateNM

VIII. Authorized Official

Name: DR. JEFFREY L BENDER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-865-7610