Provider Demographics
NPI:1215002605
Name:BANKER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BANKER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-443-5099
Mailing Address - Street 1:PO BOX 2667
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-2667
Mailing Address - Country:US
Mailing Address - Phone:804-443-5099
Mailing Address - Fax:804-443-8348
Practice Address - Street 1:215 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-5099
Practice Address - Fax:804-443-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID