Provider Demographics
NPI:1538214473
Name:BENDER, CHARLES P (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:BENDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:1139 MONTMORENCI RD
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853
Mailing Address - Country:US
Mailing Address - Phone:814-772-5555
Mailing Address - Fax:814-772-5555
Practice Address - Street 1:1139 MONTMORENCI RD
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853
Practice Address - Country:US
Practice Address - Phone:814-772-5555
Practice Address - Fax:814-772-5555
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2466L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABE104781Medicare ID - Type Unspecified