Provider Demographics
NPI:1902971393
Name:BANKER, RICHARD A (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BANKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2667
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-2667
Mailing Address - Country:US
Mailing Address - Phone:804-443-5099
Mailing Address - Fax:804-443-8348
Practice Address - Street 1:215 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-5099
Practice Address - Fax:804-443-8348
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
541920762OtherFEDERAL TAX ID
541920762OtherFEDERAL TAX ID
T78330Medicare UPIN