Provider Demographics
NPI:1710642491
Name:BEDENBAUGH, WILLIAM RIVERS (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RIVERS
Last Name:BEDENBAUGH
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 1:550 STEEDMAN RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8378
Mailing Address - Country:US
Mailing Address - Phone:803-413-4989
Mailing Address - Fax:
Practice Address - Street 1:550 STEEDMAN RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8378
Practice Address - Country:US
Practice Address - Phone:803-413-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty