Provider Demographics
NPI:1730625344
Name:MEGAN BANKER DC
Entity type:Organization
Organization Name:MEGAN BANKER DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-224-4804
Mailing Address - Street 1:2232 NW PETTYGROVE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2372
Mailing Address - Country:US
Mailing Address - Phone:503-224-4804
Mailing Address - Fax:
Practice Address - Street 1:2232 NW PETTYGROVE ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2372
Practice Address - Country:US
Practice Address - Phone:503-224-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR188504Medicare PIN