Provider Demographics
NPI:1417544008
Name:ELI BENTABOU CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ELI BENTABOU CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTABOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-331-2225
Mailing Address - Street 1:1705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9423
Mailing Address - Country:US
Mailing Address - Phone:360-331-2225
Mailing Address - Fax:
Practice Address - Street 1:1705 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9423
Practice Address - Country:US
Practice Address - Phone:360-331-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952549057OtherNPI 1