Provider Demographics
NPI:1942251608
Name:BENTLEY, CRAIG S (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:BENTLEY
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 1:67925 BANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9301
Mailing Address - Country:US
Mailing Address - Phone:740-695-5525
Mailing Address - Fax:740-695-6209
Practice Address - Street 1:67925 BANFIELD RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9301
Practice Address - Country:US
Practice Address - Phone:740-695-5525
Practice Address - Fax:740-695-6209
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH581OtherTHE HEALTH PLAN
OH000000152530OtherANTHEM
WVBE0399181OtherBRICKSTREET INS
OHBWXOther55054226000
OH581OtherTHE HEALTH PLAN