Healthcare Provider Details

I. General information

NPI: 1225081524
Provider Name (Legal Business Name): MATTHEW W BANKORD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N STATE ST
MARENGO IL
60152-2217
US

IV. Provider business mailing address

111 N STATE ST
MARENGO IL
60152-2217
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-9900
  • Fax: 815-568-9901
Mailing address:
  • Phone: 815-568-9900
  • Fax: 815-568-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-007144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: