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General NPI Number Information
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NPI Number | 1063611283
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Entity Type | Organization
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Legal Business Name | BENTLEY CHIROPRACTIC, INC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 123 E WILLIAM ST
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City | MAUMEE
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State | OH
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Zip | 43537-3349
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Country | US
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Telephone | 419-893-0231
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Fax | 419-891-6900
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Provider Business Mailing Address
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Address Line | 123 E WILLIAM ST
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City | MAUMEE
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State | OH
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Zip | 43537-3349
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Country | US
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Telephone | 419-893-0231
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Fax | 419-891-6900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL LEE BENTLEY
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Credential | DC
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Telephone | 419-893-0231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1494
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License Number State | OH
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