Provider Demographics
NPI:1730163775
Name:BALLARD, DAVID JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
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 1:15517 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2620
Mailing Address - Country:US
Mailing Address - Phone:818-830-7491
Mailing Address - Fax:818-830-7463
Practice Address - Street 1:15517 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2620
Practice Address - Country:US
Practice Address - Phone:818-830-7491
Practice Address - Fax:818-830-7463
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22250Medicare ID - Type UnspecifiedCHIROPRACTOR