Provider Demographics
NPI:1215205000
Name:BENCE CHIROPRACTIC WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:BENCE CHIROPRACTIC WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCWP
Authorized Official - Phone:586-978-9900
Mailing Address - Street 1:39573 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2744
Mailing Address - Country:US
Mailing Address - Phone:586-978-9900
Mailing Address - Fax:586-978-9908
Practice Address - Street 1:39573 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2744
Practice Address - Country:US
Practice Address - Phone:586-978-9900
Practice Address - Fax:586-978-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4285974Medicaid
MI4285974Medicaid
MIT18285Medicare UPIN