Provider Demographics
NPI:1720173941
Name:BENDER, JEREMY D (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:D
Last Name:BENDER
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 1:813 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4704
Mailing Address - Country:US
Mailing Address - Phone:316-440-4052
Mailing Address - Fax:
Practice Address - Street 1:813 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4704
Practice Address - Country:US
Practice Address - Phone:316-440-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062077OtherBLUE CROSS
KS062098OtherALLL OTHERS
KS062098OtherALLL OTHERS
KSU99557Medicare UPIN