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General NPI Number Information
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NPI Number | 1316259377
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Entity Type | Organization
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Legal Business Name | WINE COUNTRY CHIROPRACTIC MARK S. BANASIAK DC INC. A PROFESSIONAL CORP
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 27555 YNEZ RD STE 350
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City | TEMECULA
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State | CA
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Zip | 92591-4688
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Country | US
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Telephone | 951-587-2225
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Fax | 951-365-0027
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Provider Business Mailing Address
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Address Line | 29377 RANCHO CALIFORNIA RD SUITE# 106
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City | TEMECULA
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State | CA
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Zip | 92591-5206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | MARK S. BANASIAK
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Credential | D.C.
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Telephone | 951-587-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC23625
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License Number State | CA
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