Provider Demographics
NPI:1346236627
Name:BENDER FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BENDER FAMILY CHIROPRACTIC PLLC
Other - Org Name:LAKELAND CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-847-2631
Mailing Address - Street 1:119 GRAYSTONE PLAZA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501
Mailing Address - Country:US
Mailing Address - Phone:218-847-2631
Mailing Address - Fax:218-847-0048
Practice Address - Street 1:119 GRAYSTONE PLAZA
Practice Address - Street 2:SUITE 110
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501
Practice Address - Country:US
Practice Address - Phone:218-847-2631
Practice Address - Fax:218-847-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02212Medicare UPIN
C04002Medicare ID - Type Unspecified