Provider Demographics
NPI:1689696049
Name:BEND, RONALD L (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:BEND
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 1:4040 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3800
Mailing Address - Country:US
Mailing Address - Phone:810-385-0235
Mailing Address - Fax:810-385-0239
Practice Address - Street 1:4040 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3800
Practice Address - Country:US
Practice Address - Phone:810-385-0235
Practice Address - Fax:810-385-0239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor