Provider Demographics
NPI:1790770782
Name:HANKS, ROLLIE D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROLLIE
Middle Name:D
Last Name:HANKS
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 1:18856 ROSCOE BLVD
Mailing Address - Street 2:#B
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6300
Mailing Address - Country:US
Mailing Address - Phone:818-701-1058
Mailing Address - Fax:818-701-9037
Practice Address - Street 1:18856 ROSCOE BLVD
Practice Address - Street 2:#B
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6300
Practice Address - Country:US
Practice Address - Phone:818-701-1058
Practice Address - Fax:818-701-9037
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T17528Medicare UPIN
DC13539AMedicare ID - Type Unspecified