Provider Demographics
NPI:1407292048
Name:BANTON, ALEENA S (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEENA
Middle Name:S
Last Name:BANTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ROSWELL RD
Mailing Address - Street 2:APT: 1-B10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3060
Mailing Address - Country:US
Mailing Address - Phone:256-508-0951
Mailing Address - Fax:
Practice Address - Street 1:2146 ROSWELL RD
Practice Address - Street 2:SUITE 108-1002
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3802
Practice Address - Country:US
Practice Address - Phone:770-769-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO8940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor