Provider Demographics
NPI:1518017052
Name:BALLARD CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BALLARD CHIROPRACTIC CORPORATION
Other - Org Name:MISSION HILLS CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:818-830-7491
Mailing Address - Street 1:15517 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2620
Mailing Address - Country:US
Mailing Address - Phone:818-830-7491
Mailing Address - Fax:818-830-7463
Practice Address - Street 1:15517 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2620
Practice Address - Country:US
Practice Address - Phone:818-830-7491
Practice Address - Fax:818-830-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22250Medicare ID - Type UnspecifiedMEDICARE