Provider Demographics
NPI:1427226315
Name:BENTS CHIROPRACTIC CENTER, SC
Entity Type:Organization
Organization Name:BENTS CHIROPRACTIC CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-387-2990
Mailing Address - Street 1:700 E. THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449
Mailing Address - Country:US
Mailing Address - Phone:715-387-2990
Mailing Address - Fax:715-387-1290
Practice Address - Street 1:700 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4558
Practice Address - Country:US
Practice Address - Phone:715-387-2990
Practice Address - Fax:715-387-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38790600Medicaid
WI38790600Medicaid