Provider Demographics
NPI:1851576565
Name:BENTZ, JEFFREY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:BENTZ
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 1:9066 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5395
Mailing Address - Country:US
Mailing Address - Phone:412-847-0066
Mailing Address - Fax:412-847-0067
Practice Address - Street 1:9066 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5395
Practice Address - Country:US
Practice Address - Phone:412-847-0066
Practice Address - Fax:412-847-0067
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2040299OtherHIGHMARK BLUE SHIELD
PA125867J8WMedicare PIN