Provider Demographics
NPI:1760819080
Name:BANER, ARTHUR CHANDLER (LMP)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:CHANDLER
Last Name:BANER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9742
Mailing Address - Country:US
Mailing Address - Phone:360-318-4433
Mailing Address - Fax:
Practice Address - Street 1:7371 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9742
Practice Address - Country:US
Practice Address - Phone:360-318-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist