Provider Demographics
NPI:1548294200
Name:BALLARD, MELVIN KERRY (DC)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:KERRY
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 1:932 S MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5555
Mailing Address - Country:US
Mailing Address - Phone:928-536-3550
Mailing Address - Fax:928-536-3552
Practice Address - Street 1:932 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5555
Practice Address - Country:US
Practice Address - Phone:928-536-3550
Practice Address - Fax:928-536-3552
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77372Medicare ID - Type UnspecifiedGROUP NUMBER
AZZ77374Medicare PIN