Healthcare Provider Details

I. General information

NPI: 1174935092
Provider Name (Legal Business Name): BANKS FAMILY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 06/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 LEE ST STE 207
DES PLAINES IL
60016-6465
US

IV. Provider business mailing address

880 LEE ST SUITE 207
DES PLAINES IL
60016-6420
US

V. Phone/Fax

Practice location:
  • Phone: 712-790-9420
  • Fax:
Mailing address:
  • Phone: 847-768-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012630
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY DONALD BANKS
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 712-790-9420