Provider Demographics
NPI:1205365590
Name:BANKS, JILLIAN (DC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 WASHINGTON ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4045
Mailing Address - Country:US
Mailing Address - Phone:781-771-7157
Mailing Address - Fax:
Practice Address - Street 1:59 POND ST APT A
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2064
Practice Address - Country:US
Practice Address - Phone:781-806-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor