Provider Demographics
NPI:1356546188
Name:SCOTT J BANKS DOCTOR OF CHIROPRACTIC
Entity type:Organization
Organization Name:SCOTT J BANKS DOCTOR OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-271-0770
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-271-0770
Mailing Address - Fax:631-271-0786
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-271-0770
Practice Address - Fax:631-271-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0030521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1640097OtherOXFORD
NYC03052-0OtherPC
NY0040687OtherGHI
NY4300220OtherAETNA
NY70709OtherUNITED HEALTHCARE
NY127039Medicare UPIN
NYX899401Medicare UPIN
NY0040687OtherGHI
NY70709OtherUNITED HEALTHCARE