MEDICARE: MR. CARY LELAND BANEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2001012377	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	143494	OTHER	BCBS OF MO
2	466683	OTHER	HEALTHLINK
3	629911	OTHER	UHC CHOICE PLUS
4	P00071242 DA7685	OTHER	ALL
5	629911	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1497757280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARY LELAND BANEY DC

Provider Business Mailing Address
First Line	:	108 W 2ND ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1813
Country	:	US
Telephone Number	:	573-564-3600
Fax Number	:	573-564-3600

Provider Business Practice Location Address
First Line	:	108 W 2ND ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1813
Country	:	US
Telephone Number	:	573-564-3600
Fax Number	:	573-564-3600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/05/2012

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