Provider Demographics
NPI:1437435807
Name:SUBURBAN X-RAY, LTD
Entity Type:Organization
Organization Name:SUBURBAN X-RAY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-529-0077
Mailing Address - Street 1:7N315 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9799
Mailing Address - Country:US
Mailing Address - Phone:630-529-0077
Mailing Address - Fax:630-529-0087
Practice Address - Street 1:3113 CALWAGNER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2622
Practice Address - Country:US
Practice Address - Phone:630-529-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-006504111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty