Provider Demographics
NPI:1568460582
Name:BENTLEY, ANTHONY J (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
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 1:3630 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5228
Mailing Address - Country:US
Mailing Address - Phone:513-423-0550
Mailing Address - Fax:513-423-5171
Practice Address - Street 1:4421 ROOSEVELT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6239
Practice Address - Country:US
Practice Address - Phone:513-423-0550
Practice Address - Fax:513-423-5171
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000179781OtherANTHEM PROVIDER#
OH31-1733056OtherTAX ID#
OH2092471Medicaid
OH311733056-00OtherBWC PROVIDER#
OH000000179781OtherANTHEM PROVIDER#
OH311733056-00OtherBWC PROVIDER#
OH31-1733056Medicare PIN