MEDICARE: DR. BEAU JAMES BANTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4741-12	WI

General Provider Information

NPI Number	:	1053602821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEAU JAMES BANTON D.C.

Provider Business Mailing Address
First Line	:	3510 N OAKLAND AVE STE 201
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2746
Country	:	US
Telephone Number	:	414-962-0700
Fax Number	:	414-271-1727

Provider Business Practice Location Address
First Line	:	3510 N OAKLAND AVE STE 201
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2746
Country	:	US
Telephone Number	:	144-962-0700
Fax Number	:	414-271-1727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	08/29/2019

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