Provider Demographics
NPI:1891878872
Name:BENDAVID, JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:BENDAVID
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JACQUES
Other - Middle Name:
Other - Last Name:BENDAVID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6107 BLUEBELL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4414
Mailing Address - Country:US
Mailing Address - Phone:818-755-8588
Mailing Address - Fax:818-755-8861
Practice Address - Street 1:12444 VICTORY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VALLEY GLEN
Practice Address - State:CA
Practice Address - Zip Code:91606-3156
Practice Address - Country:US
Practice Address - Phone:818-755-8588
Practice Address - Fax:818-755-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891878872OtherNPI#
CAH-98-40451-4OtherDEPT HEALTH/HUMAN SERVICES OI FILE #
CA68-0603965OtherTAX ID #