=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912038563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANKS CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 E MOUNT PLEASANT ST
-----------------------------------------------------
City | WEST BURLINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52655-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-753-5441
-----------------------------------------------------
Fax | 319-753-5442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 E MOUNT PLEASANT ST
-----------------------------------------------------
City | WEST BURLINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52655-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-753-5441
-----------------------------------------------------
Fax | 319-753-5442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DOUGLAS JAMES HANKS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 319-753-5441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | A05646
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------