Provider Demographics
NPI:1134542285
Name:BALLARD, JONATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BALLARD
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 1:435 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3208
Mailing Address - Country:US
Mailing Address - Phone:918-272-8054
Mailing Address - Fax:918-274-8044
Practice Address - Street 1:435 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3208
Practice Address - Country:US
Practice Address - Phone:918-272-8054
Practice Address - Fax:918-274-8044
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor