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General NPI Number Information
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NPI Number | 1801126966
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Entity Type | Individual
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Provider Name | HOLLI ETHEL BANES DC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 29990 HUNTER RD STE 101
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City | MURRIETA
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State | CA
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Zip | 92563-2768
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Country | US
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Telephone | 951-473-2281
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Fax |
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Provider Business Mailing Address
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Address Line | 30434 SAVOIE ST
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City | MURRIETA
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State | CA
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Zip | 92563
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Country | US
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Telephone | 918-232-5889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC-31660
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC31660
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License Number State | CA
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