Provider Demographics
NPI:1114129244
Name:BALLARD CHIROPRACTIC CLINIC, PS
Entity Type:Organization
Organization Name:BALLARD CHIROPRACTIC CLINIC, PS
Other - Org Name:BALLARD CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:WECHSELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-782-8500
Mailing Address - Street 1:9015 HOLMAN RD NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3481
Mailing Address - Country:US
Mailing Address - Phone:206-782-8500
Mailing Address - Fax:206-784-4020
Practice Address - Street 1:9015 HOLMAN RD NW
Practice Address - Street 2:SUITE 3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3481
Practice Address - Country:US
Practice Address - Phone:206-782-8500
Practice Address - Fax:206-784-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002000111N00000X
WAMA00016624225700000X
WAMA00017258225700000X
WAMA00009765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty