Provider Demographics
NPI:1770535676
Name:BANKS, ROBERT H (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:BANKS
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 1:326 CENTER AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7302
Mailing Address - Country:US
Mailing Address - Phone:907-486-4042
Mailing Address - Fax:907-486-1033
Practice Address - Street 1:326 CENTER AVE
Practice Address - Street 2:STE 100
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7302
Practice Address - Country:US
Practice Address - Phone:907-486-6906
Practice Address - Fax:907-486-1033
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH02581Medicaid
AKK160510Medicare PIN
AKCH02581Medicaid