Provider Demographics
NPI:1639352917
Name:BANKS, GREGORY DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DONALD
Last Name:BANKS
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 1:880 LEE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6465
Mailing Address - Country:US
Mailing Address - Phone:847-768-9330
Mailing Address - Fax:847-768-9336
Practice Address - Street 1:880 LEE ST STE 207
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6465
Practice Address - Country:US
Practice Address - Phone:847-768-9330
Practice Address - Fax:847-768-9336
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007022111N00000X
IL038012630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor