Provider Demographics
NPI:1295041572
Name:LAWRENCE J BENTVENA DC PA
Entity Type:Organization
Organization Name:LAWRENCE J BENTVENA DC PA
Other - Org Name:MIDCOUNTY CHIROPRACTIC & REHABILITATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENTVENA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-433-8500
Mailing Address - Street 1:6252 S CONGRESS AVE
Mailing Address - Street 2:SUITE J1
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2352
Mailing Address - Country:US
Mailing Address - Phone:561-433-8500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8760261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service