Provider Demographics
NPI:1366453557
Name:BANIK CHIROPRACTIC HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:BANIK CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-799-1423
Mailing Address - Street 1:1151 EL CENTRO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5721
Mailing Address - Country:US
Mailing Address - Phone:626-799-1423
Mailing Address - Fax:626-799-1453
Practice Address - Street 1:1151 EL CENTRO ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5721
Practice Address - Country:US
Practice Address - Phone:626-799-1423
Practice Address - Fax:626-799-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN
CAW18745Medicare ID - Type Unspecified