Provider Demographics
NPI:1285645234
Name:BENTVENA, LAWRENCE J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:BENTVENA
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:14804 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7830
Mailing Address - Country:US
Mailing Address - Phone:561-512-3890
Mailing Address - Fax:561-641-6821
Practice Address - Street 1:6252 S CONGRESS AVE
Practice Address - Street 2:SUITE J1
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2352
Practice Address - Country:US
Practice Address - Phone:561-433-8500
Practice Address - Fax:561-641-6821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH 8760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor