Provider Demographics
NPI:1790705986
Name:BANKS, DAVID BLAIR (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BLAIR
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 1:2406 PEBBLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2719
Mailing Address - Country:US
Mailing Address - Phone:972-660-5503
Mailing Address - Fax:
Practice Address - Street 1:1055 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4706
Practice Address - Country:US
Practice Address - Phone:972-660-5141
Practice Address - Fax:972-660-4563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
601201OtherBLUE CROSS BLUE SHIELD #
TXT12062Medicare UPIN