Provider Demographics
NPI:1750583076
Name:BAN, AGI E (DC)
Entity type:Individual
Prefix:DR
First Name:AGI
Middle Name:E
Last Name:BAN
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 1:615 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1919
Mailing Address - Country:US
Mailing Address - Phone:510-845-4540
Mailing Address - Fax:510-848-6569
Practice Address - Street 1:615 ADDISON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1919
Practice Address - Country:US
Practice Address - Phone:510-845-4540
Practice Address - Fax:510-848-6569
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21225OtherCHIROPRACTIC LICENSE