Provider Demographics
NPI:1548422546
Name:BEND WHOLE HEALTH PC
Entity Type:Organization
Organization Name:BEND WHOLE HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-389-1191
Mailing Address - Street 1:354 NE NORTON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4392
Mailing Address - Country:US
Mailing Address - Phone:541-389-1191
Mailing Address - Fax:541-389-1972
Practice Address - Street 1:354 NE NORTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4392
Practice Address - Country:US
Practice Address - Phone:541-389-1191
Practice Address - Fax:541-389-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142109Medicare PIN