Provider Demographics
NPI:1548523848
Name:BANKS, RYAN SCOTT (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:BANKS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416
Mailing Address - Country:US
Mailing Address - Phone:810-346-4300
Mailing Address - Fax:810-346-4304
Practice Address - Street 1:4444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416
Practice Address - Country:US
Practice Address - Phone:810-346-4300
Practice Address - Fax:810-346-4304
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9735002Medicare PIN