Healthcare Provider Details

I. General information

NPI: 1548523848
Provider Name (Legal Business Name): RYAN SCOTT BANKS CHIROPRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MAIN ST
BROWN CITY MI
48416
US

IV. Provider business mailing address

4444 MAIN ST
BROWN CITY MI
48416
US

V. Phone/Fax

Practice location:
  • Phone: 810-346-4300
  • Fax: 810-346-4304
Mailing address:
  • Phone: 810-346-4300
  • Fax: 810-346-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010145
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: