Provider Demographics
NPI:1679681100
Name:HANKS, ROBERT LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:HANKS
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 1:723 NORTH LAKE ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546
Mailing Address - Country:US
Mailing Address - Phone:337-824-5522
Mailing Address - Fax:337-824-5527
Practice Address - Street 1:723 NORTH LAKE ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546
Practice Address - Country:US
Practice Address - Phone:337-824-5522
Practice Address - Fax:337-824-5527
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81901Medicare UPIN
LA5CH55Medicare ID - Type Unspecified