Provider Demographics
NPI:1376720870
Name:BENDEWALD, CARLY OVERBY (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:OVERBY
Last Name:BENDEWALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 DYER ST
Mailing Address - Street 2:STE 3
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5003
Mailing Address - Country:US
Mailing Address - Phone:214-843-1233
Mailing Address - Fax:
Practice Address - Street 1:5639 DYER ST
Practice Address - Street 2:STE 3
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5003
Practice Address - Country:US
Practice Address - Phone:214-843-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor