Provider Demographics
NPI:1518297670
Name:BANES, STEPHEN KYLE (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KYLE
Last Name:BANES
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 1:29990 HUNTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2768
Mailing Address - Country:US
Mailing Address - Phone:918-521-8409
Mailing Address - Fax:
Practice Address - Street 1:29990 HUNTER RD STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2768
Practice Address - Country:US
Practice Address - Phone:918-521-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31661111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation