Provider Demographics
NPI:1669685202
Name:BANDA, MAGDALENO JR (DC)
Entity Type:Individual
Prefix:
First Name:MAGDALENO
Middle Name:
Last Name:BANDA
Suffix:JR
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 1:4413 KINGFISH DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-2568
Mailing Address - Country:US
Mailing Address - Phone:713-859-3797
Mailing Address - Fax:281-474-2914
Practice Address - Street 1:8225 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-4503
Practice Address - Country:US
Practice Address - Phone:713-649-8808
Practice Address - Fax:713-649-8823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9051111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation