Bespoke Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

BESPOKE CHIROPRACTIC LLC

Practice address

413 High St
Waterford, PA 16441-8301

Phone

(814) 796-3535

Fax

(814) 796-3535

NPI assigned

Oct 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin Bowler, DCNPI 1477122794

Title

Owner

Phone

(814) 796-3535

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chiropractic Works Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Benjamin Bowler, DC

  • Chiropractor
  • Waterford, PA
  • NPI 1477122794
  Medicare reassignment NPD Authorized official
• Benjamin C Delong, D.C.

  • Chiropractor
  • Waterford, PA
  • NPI 1932369436
  NPD (past)
• Kristine M. Nelson, D.C.

  • Chiropractor
  • Waterford, PA
  • NPI 1003905399
  NPD (past)
• Timothy Ryan Purcell, D.C.

  • Chiropractor
  • Edinboro, PA
  • NPI 1285634147
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1558024661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "WATERFORD",
            "state": "PA",
            "postal_code": "164410457",
            "telephone_number": "814-796-3535",
            "fax_number": "814-796-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 HIGH ST",
            "city": "WATERFORD",
            "state": "PA",
            "postal_code": "164418301",
            "telephone_number": "814-796-3535",
            "fax_number": "814-796-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BESPOKE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-15",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "BOWLER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-796-3535",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA",
            "identifier": "DC011649",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chiropractic Works",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marissa Nichole Altmeyer, PA-C
• Amhx2
• Stephen Asare
• Micalyn D Baney, DO
• Bryan Leo Batkiewicz, PT
• Benjamin Bowler, DC
• Brian E Lentz DMD PC
• Craig Douglas Caldwell, DO
• Amanda M Cole, LSW
• Jennifer Sue Coleman, MSCCCSLP

• Chiropractor in Waterford, PA
• Providers in Waterford, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.