Provider Demographics
NPI:1891940706
Name:BENGARD, SHELLEY ANN (DC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:BENGARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:ANN
Other - Last Name:BURMAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2090 SMOKETREE AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5806
Mailing Address - Country:US
Mailing Address - Phone:928-208-5948
Mailing Address - Fax:
Practice Address - Street 1:60 S. ACOMA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-453-1055
Practice Address - Fax:928-453-1057
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor