Provider Demographics
NPI:1447297031
Name:BENDER, EDWARD SWANTON (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SWANTON
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 1:100 MADRID BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7968
Mailing Address - Country:US
Mailing Address - Phone:941-637-6090
Mailing Address - Fax:941-637-6010
Practice Address - Street 1:100 MADRID BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7968
Practice Address - Country:US
Practice Address - Phone:941-637-6090
Practice Address - Fax:941-637-6010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH4849OtherDEPT OF HEALTH LICENSE
FL70553Medicare ID - Type Unspecified