Provider Demographics
NPI:1235298894
Name:BALOVICH, NICHOLAS M III (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:M
Last Name:BALOVICH
Suffix:III
Gender:M
Credentials:DC
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Mailing Address - Street 1:1510 BREEZEPORT WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3736
Mailing Address - Country:US
Mailing Address - Phone:757-483-0177
Mailing Address - Fax:757-483-3991
Practice Address - Street 1:1510 BREEZEPORT WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3736
Practice Address - Country:US
Practice Address - Phone:757-483-0177
Practice Address - Fax:757-483-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0104556306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor