Provider Demographics
NPI:1346295748
Name:BANIC, ANTE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTE
Middle Name:
Last Name:BANIC
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BANIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1505 NW GILMAN BLVD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5398
Mailing Address - Country:US
Mailing Address - Phone:206-852-8240
Mailing Address - Fax:
Practice Address - Street 1:1505 NW GILMAN BLVD
Practice Address - Street 2:SUITE #8
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-313-9222
Practice Address - Fax:425-313-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU99123Medicare UPIN
WAG8802246Medicare ID - Type Unspecified