Provider Demographics
NPI:1326182841
Name:BALLANTYNE ADVANCED CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BALLANTYNE ADVANCED CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-541-7676
Mailing Address - Street 1:8634 CAMFIELD ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3145
Mailing Address - Country:US
Mailing Address - Phone:704-541-7676
Mailing Address - Fax:704-541-7989
Practice Address - Street 1:8634 CAMFIELD ST STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3145
Practice Address - Country:US
Practice Address - Phone:704-541-7676
Practice Address - Fax:704-541-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335960Medicare PIN