Provider Demographics
NPI:1497757280
Name:BANEY, CARY LELAND (DC)
Entity Type:Individual
Prefix:MR
First Name:CARY
Middle Name:LELAND
Last Name:BANEY
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 1:108 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1813
Mailing Address - Country:US
Mailing Address - Phone:573-564-3600
Mailing Address - Fax:573-564-3600
Practice Address - Street 1:108 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1813
Practice Address - Country:US
Practice Address - Phone:573-564-3600
Practice Address - Fax:573-564-3600
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
143494OtherBCBS OF MO
466683OtherHEALTHLINK
629911OtherUHC CHOICE PLUS
P00071242 DA7685OtherALL
629911OtherUNITED HEALTHCARE
466683OtherHEALTHLINK
143494OtherBCBS OF MO