Provider Demographics
NPI:1154472249
Name:BALLI, SERGIO ARTURO (DC)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ARTURO
Last Name:BALLI
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 1:6789 N WILLOW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5959
Mailing Address - Country:US
Mailing Address - Phone:559-298-6325
Mailing Address - Fax:559-298-6322
Practice Address - Street 1:6789 N WILLOW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5959
Practice Address - Country:US
Practice Address - Phone:559-298-6325
Practice Address - Fax:559-298-6322
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0296670Medicare ID - Type Unspecified