Provider Demographics
NPI:1013020049
Name:BALLIS, LOUIE T (DC)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:T
Last Name:BALLIS
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 1:2170 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3106
Mailing Address - Country:US
Mailing Address - Phone:318-746-4445
Mailing Address - Fax:318-746-0353
Practice Address - Street 1:2170 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-746-4445
Practice Address - Fax:318-746-0353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2918AOtherBLUE CROSS BLUE SHIELD
LA59401Medicare ID - Type Unspecified