Provider Demographics
NPI:1992842124
Name:BENDER, JAN L (DC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:BENDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SW 12TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2034
Mailing Address - Country:US
Mailing Address - Phone:503-224-2425
Mailing Address - Fax:503-224-7512
Practice Address - Street 1:1201 SW 12TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2034
Practice Address - Country:US
Practice Address - Phone:503-224-2425
Practice Address - Fax:503-224-7512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor