Provider Demographics
NPI:1104029420
Name:TED BANKO DC
Entity Type:Organization
Organization Name:TED BANKO DC
Other - Org Name:BANKO CHIROPRACTIC CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACKENSTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-751-1289
Mailing Address - Street 1:3615 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5113
Mailing Address - Country:US
Mailing Address - Phone:610-252-2216
Mailing Address - Fax:
Practice Address - Street 1:3615 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5113
Practice Address - Country:US
Practice Address - Phone:610-252-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001707L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064085Medicare ID - Type Unspecified