Provider Demographics
NPI:1942277975
Name:BANISTER, LINDA (DC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BANISTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:BANISTER
Other - Last Name:ZENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:826 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-859-7919
Mailing Address - Fax:904-249-1530
Practice Address - Street 1:826 13TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4752
Practice Address - Country:US
Practice Address - Phone:904-859-7919
Practice Address - Fax:904-249-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056305600Medicaid
FL70528AMedicare ID - Type Unspecified
FL056305600Medicaid