=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689696049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD L BEND DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4040 24TH AVE
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-385-0235
-----------------------------------------------------
Fax | 810-385-0239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4040 24TH AVE
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-385-0235
-----------------------------------------------------
Fax | 810-385-0239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301008935
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------