Provider Demographics
NPI:1164761581
Name:BALLAM, JOHN FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:BALLAM
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 1:201 DAVIS GROVE CIR STE 106
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-2513
Mailing Address - Country:US
Mailing Address - Phone:919-363-2277
Mailing Address - Fax:
Practice Address - Street 1:201 DAVIS GROVE CIR
Practice Address - Street 2:SUITE 106
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-2512
Practice Address - Country:US
Practice Address - Phone:515-509-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor