Provider Demographics
NPI:1083602627
Name:BALLEW, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BALLEW
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 1:256 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4857
Mailing Address - Country:US
Mailing Address - Phone:207-873-1167
Mailing Address - Fax:207-873-1168
Practice Address - Street 1:256 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4857
Practice Address - Country:US
Practice Address - Phone:207-873-1167
Practice Address - Fax:207-873-1168
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114420099Medicaid
MEME0524OtherHARVARD PILGRIM
ME024433OtherANTHEM
MEM68601OtherCIGNA
MEME0524OtherHARVARD PILGRIM
MET31308Medicare UPIN