Provider Demographics
NPI:1497782254
Name:BENTLEY, MICHAEL L (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3349
Mailing Address - Country:US
Mailing Address - Phone:419-893-0231
Mailing Address - Fax:419-891-6900
Practice Address - Street 1:123 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3349
Practice Address - Country:US
Practice Address - Phone:419-893-0231
Practice Address - Fax:419-891-6900
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1063611283Medicare PIN
OHBE0662983Medicare ID - Type Unspecified
OH1497782254Medicare PIN
OHU01759Medicare UPIN