MEDICARE: JEFFREY L BENDER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1247	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201000668	OTHER	NM	PRESBYTERIAN
2	00KP19	OTHER	NM	BC/BS

General Provider Information

NPI Number	:	1215031257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L BENDER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 2927
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-2927
Country	:	US
Telephone Number	:	505-865-7610
Fax Number	:	505-865-8673

Provider Business Practice Location Address
First Line	:	209 HIGHWAY 314 NW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6697
Country	:	US
Telephone Number	:	505-865-7610
Fax Number	:	505-865-8673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/15/2014

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