Provider Demographics
NPI:1841432747
Name:BANTZ, ERIC ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:BANTZ
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 1:105 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5153
Mailing Address - Country:US
Mailing Address - Phone:641-752-1010
Mailing Address - Fax:641-752-7349
Practice Address - Street 1:105 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5153
Practice Address - Country:US
Practice Address - Phone:641-752-1010
Practice Address - Fax:641-752-7349
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor