Provider Demographics
NPI:1063446797
Name:BOREN, BALLARD RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:BALLARD
Middle Name:RAY
Last Name:BOREN
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 1:70 42ND ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5220
Mailing Address - Country:US
Mailing Address - Phone:903-785-5551
Mailing Address - Fax:903-784-4188
Practice Address - Street 1:70 42ND ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5220
Practice Address - Country:US
Practice Address - Phone:903-785-5551
Practice Address - Fax:903-784-4188
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19589Medicare UPIN
TX87620KMedicare ID - Type Unspecified