Provider Demographics
NPI:1457733610
Name:EASTON CHIROPRACTIC AND REHAB PLLC
Entity Type:Organization
Organization Name:EASTON CHIROPRACTIC AND REHAB PLLC
Other - Org Name:BANKO CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:RAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-622-8501
Mailing Address - Street 1:3615 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5113
Mailing Address - Country:US
Mailing Address - Phone:610-252-2216
Mailing Address - Fax:610-252-5597
Practice Address - Street 1:3615 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5113
Practice Address - Country:US
Practice Address - Phone:610-252-2216
Practice Address - Fax:610-252-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011019111N00000X
PAPT022782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty