Provider Demographics
NPI:1407972482
Name:RICHARD D BALLARD DC
Entity Type:Organization
Organization Name:RICHARD D BALLARD DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-283-9683
Mailing Address - Street 1:PO BOX 4656
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4656
Mailing Address - Country:US
Mailing Address - Phone:423-283-9683
Mailing Address - Fax:423-283-9685
Practice Address - Street 1:1102 SUNSET DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3673
Practice Address - Country:US
Practice Address - Phone:423-283-9683
Practice Address - Fax:423-283-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4050652OtherBCBSTN
TN1033143938OtherCIGNA PROVIDER ID
TN5756110001OtherDME SUPPLIER ID
TN1033143938OtherCIGNA PROVIDER ID
TNU90407Medicare UPIN