Provider Demographics
NPI:1437316627
Name:DAX PHYSICAL MEDICINE P C
Entity Type:Organization
Organization Name:DAX PHYSICAL MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDIKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-399-2169
Mailing Address - Street 1:400 W HWY 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5148
Mailing Address - Country:US
Mailing Address - Phone:956-399-2169
Mailing Address - Fax:956-399-0312
Practice Address - Street 1:400 W HWY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5148
Practice Address - Country:US
Practice Address - Phone:956-399-2169
Practice Address - Fax:956-399-0312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAX PHYSICAL MEDICINE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2923111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM1990OtherBCBS
TXT12166Medicare UPIN