Provider Demographics
NPI:1558692988
Name:BENCH, THOMAS R (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BENCH
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 1:1410 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6269
Mailing Address - Country:US
Mailing Address - Phone:208-552-9600
Mailing Address - Fax:208-524-6402
Practice Address - Street 1:1410 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6269
Practice Address - Country:US
Practice Address - Phone:208-552-9600
Practice Address - Fax:208-524-6402
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor