Provider Demographics
NPI:1386690634
Name:DISCOVER CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALLIF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-826-5548
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:408 N. MAIN
Mailing Address - City:CONCONULLY
Mailing Address - State:WA
Mailing Address - Zip Code:98819-0324
Mailing Address - Country:US
Mailing Address - Phone:509-826-5548
Mailing Address - Fax:
Practice Address - Street 1:408 N. MAIN
Practice Address - Street 2:
Practice Address - City:CONCONULLY
Practice Address - State:WA
Practice Address - Zip Code:98819
Practice Address - Country:US
Practice Address - Phone:509-826-5548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT76479Medicare UPIN
WA8860067Medicare PIN