Provider Demographics
NPI:1730658105
Name:BANNISTER, DAVID ALAN (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:BANNISTER
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 1:220 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-0175
Mailing Address - Country:US
Mailing Address - Phone:304-363-4134
Mailing Address - Fax:304-333-2054
Practice Address - Street 1:220 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-0175
Practice Address - Country:US
Practice Address - Phone:304-363-4134
Practice Address - Fax:304-333-2054
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor