Provider Demographics
NPI:1255471058
Name:BANKS, SCOTT D (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
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 1:1 MOON COURT
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-2351
Mailing Address - Country:US
Mailing Address - Phone:757-331-1190
Mailing Address - Fax:757-331-1260
Practice Address - Street 1:117 MASON AVE
Practice Address - Street 2:STE F
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-3121
Practice Address - Country:US
Practice Address - Phone:757-331-1190
Practice Address - Fax:757-331-1260
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V221S17Medicare ID - Type Unspecified
T21779Medicare UPIN