Provider Demographics
NPI:1801103320
Name:ROGER BENTER DC PC
Entity type:Organization
Organization Name:ROGER BENTER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-627-4345
Mailing Address - Street 1:320 N HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1513
Mailing Address - Country:US
Mailing Address - Phone:231-627-4345
Mailing Address - Fax:231-627-4491
Practice Address - Street 1:320 N HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1513
Practice Address - Country:US
Practice Address - Phone:231-627-4345
Practice Address - Fax:231-627-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A65006Medicare PIN