Provider Demographics
NPI:1871516849
Name:EDWARD S BENDER DC,PA
Entity type:Organization
Organization Name:EDWARD S BENDER DC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SWANTON
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-637-6090
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84478Medicare UPIN
FL70553Medicare ID - Type Unspecified