Provider Demographics
NPI:1639199177
Name:FIKSDAL, BENT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BENT
Middle Name:DAVID
Last Name:FIKSDAL
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 1:1430 EAST AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1628
Mailing Address - Country:US
Mailing Address - Phone:530-343-1111
Mailing Address - Fax:530-343-4162
Practice Address - Street 1:1430 EAST AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1628
Practice Address - Country:US
Practice Address - Phone:530-343-1111
Practice Address - Fax:530-343-4162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0140310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT60416Medicare UPIN
CADC0140310Medicare ID - Type Unspecified