Provider Demographics
NPI:1093496259
Name:BANKS, LAMONT N JR (DC)
Entity Type:Individual
Prefix:
First Name:LAMONT
Middle Name:N
Last Name:BANKS
Suffix:JR
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 1:2447 SANTA CLARA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4535
Mailing Address - Country:US
Mailing Address - Phone:510-774-2933
Mailing Address - Fax:341-512-9645
Practice Address - Street 1:2447 SANTA CLARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4535
Practice Address - Country:US
Practice Address - Phone:510-774-2933
Practice Address - Fax:341-512-9645
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36723111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician