Provider Demographics
NPI:1124227129
Name:BANKUS CHIROPRACTIC
Entity Type:Organization
Organization Name:BANKUS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BANKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-265-4900
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-0207
Mailing Address - Country:US
Mailing Address - Phone:660-265-4900
Mailing Address - Fax:660-265-4901
Practice Address - Street 1:709 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-2465
Practice Address - Country:US
Practice Address - Phone:660-265-4900
Practice Address - Fax:660-265-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty