Provider Demographics
NPI:1962587154
Name:BANDA, JOHN S (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:BANDA
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 1:12609 N FEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4412
Mailing Address - Country:US
Mailing Address - Phone:281-481-4492
Mailing Address - Fax:281-481-6278
Practice Address - Street 1:12609 N FEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4412
Practice Address - Country:US
Practice Address - Phone:281-481-4492
Practice Address - Fax:281-481-6278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC-8022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5507572OtherAETNA
TX607104OtherBCBS
TX607104OtherBCBS