Provider Demographics
NPI:1497009054
Name:BALL, ANDREW (LAC, DIPLOM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 MARY AVE NW
Mailing Address - Street 2:UNIT 303
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5365
Mailing Address - Country:US
Mailing Address - Phone:773-458-0587
Mailing Address - Fax:
Practice Address - Street 1:600 N 36TH ST
Practice Address - Street 2:SUITE 426
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8697
Practice Address - Country:US
Practice Address - Phone:773-458-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60306480171100000X
IL198.001022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist