MEDICARE: BENCE CHIROPRACTIC WELLNESS CENTER, PLLC

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	2301005267	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215205000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCE CHIROPRACTIC WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	39573 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2744
Country	:	US
Telephone Number	:	586-978-9900
Fax Number	:	586-978-9908

Provider Business Practice Location Address
First Line	:	39573 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2744
Country	:	US
Telephone Number	:	586-978-9900
Fax Number	:	586-978-9908

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAVEL BENCE
Credential	:	D.C., C.C.W.P.
Telephone Number	:	586-978-9900

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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