Provider Demographics
NPI:1609069632
Name:BANIC CHIROPRACTIC COMPANY
Entity Type:Organization
Organization Name:BANIC CHIROPRACTIC COMPANY
Other - Org Name:BANIC CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BANIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-313-9222
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:425-313-9222
Mailing Address - Fax:
Practice Address - Street 1:72 E SUNSET WAY
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty