Provider Demographics
NPI:1144229485
Name:BANKS, WILLARD DEAN (DC)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:DEAN
Last Name:BANKS
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 1:1920 2ND LOOP RD.
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:1920 2ND LOOP RD.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-678-9777
Practice Address - Fax:843-665-2814
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1574Medicaid
U30082Medicare UPIN
SCCH1574Medicaid