Provider Demographics
NPI:1891984001
Name:BANACKI CHIROPRACTIC SERVICES INC
Entity Type:Organization
Organization Name:BANACKI CHIROPRACTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-786-8991
Mailing Address - Street 1:2429 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2633
Mailing Address - Country:US
Mailing Address - Phone:727-786-8991
Mailing Address - Fax:727-784-1317
Practice Address - Street 1:2429 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2633
Practice Address - Country:US
Practice Address - Phone:727-786-8991
Practice Address - Fax:727-784-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4858111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050461100Medicaid
FLT55025Medicare UPIN