Provider Demographics
NPI:1245366004
Name:HANKS, BRIAN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WAYNE
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 1:6660 OLD 28TH ST SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6954
Mailing Address - Country:US
Mailing Address - Phone:616-920-0833
Mailing Address - Fax:
Practice Address - Street 1:6660 OLD 28TH ST SE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6954
Practice Address - Country:US
Practice Address - Phone:616-920-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor