MEDICARE: CARY BANEY

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 State	Provider Identifier Issuer
1	143494	OTHER	MO	BLUE CROSS MISSOUR
2	1497757280	OTHER	MO	INDIVIDUAL NPI #
3	466683	OTHER	MO	HEALTHLINK
4	629911	OTHER	MO	ACN

General Provider Information

NPI Number	:	1790984516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARY BANEY

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	:	OWNER
Name	:	MR. CARY BANEY
Credential	:	D.C.
Telephone Number	:	573-564-3600

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	12/05/2012

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Directions to “CARY BANEY ” Practice Location

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