Provider Demographics
NPI:1871583971
Name:BENTSON, JAMES (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BENTSON
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 1:278 MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1221
Mailing Address - Country:US
Mailing Address - Phone:516-520-2998
Mailing Address - Fax:
Practice Address - Street 1:161 LEVITTOWN PKWY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4468
Practice Address - Country:US
Practice Address - Phone:516-931-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007195-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX39091Medicare ID - Type Unspecified
NYU53332Medicare UPIN