Provider Demographics
NPI:1881076404
Name:BANWART, THAYER (DC)
Entity type:Individual
Prefix:DR
First Name:THAYER
Middle Name:
Last Name:BANWART
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 1:304 SW SEAGULL ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4514
Mailing Address - Country:US
Mailing Address - Phone:913-602-2866
Mailing Address - Fax:
Practice Address - Street 1:4609 PASEO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1843
Practice Address - Country:US
Practice Address - Phone:913-602-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015018443111N00000X
KS01-05732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912577461OtherTYPE 2 ORGANIZATION NPI PECULIAR CHIROPRACTIC
MO58109017OtherARC BCBS PROVIDER ID
MO1619465945OtherTYPE 2 ORGANIZATION NPI ARC
MO65182016OtherPECULIAR CHIROPRACTIC BCBS PROVIDER ID