MEDICARE: ALAN JAMES BANASZYNSKI 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	2000153521	MO

General Provider Information

NPI Number	:	1598816035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN JAMES BANASZYNSKI DC

Provider Business Mailing Address
First Line	:	485 WILDWOOD PKWY STE 4
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2667
Country	:	US
Telephone Number	:	314-567-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 WILDWOOD PKWY STE 4
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2667
Country	:	US
Telephone Number	:	314-567-5200
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	05/14/2024

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