=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861797342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY L. BENDER, D.C., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2011
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 HIGHWAY 314 NW
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-7610
-----------------------------------------------------
Fax | 505-865-8673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2927
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-7610
-----------------------------------------------------
Fax | 505-865-8673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY L BENDER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 505-865-7610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1247
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------