Provider Demographics
NPI:1174590095
Name:BANACKI, JOHN RAMON (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAMON
Last Name:BANACKI
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 1:2429 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2633
Mailing Address - Country:US
Mailing Address - Phone:727-786-8991
Mailing Address - Fax:
Practice Address - Street 1:2429 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2633
Practice Address - Country:US
Practice Address - Phone:727-786-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4858111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74889OtherMEDICARE GROUP ID #
FLT55025Medicare UPIN
FL70634Medicare ID - Type UnspecifiedPROVIDER NUMBER