Provider Demographics
NPI:1558142448
Name:BALOG, JAROD (DC)
Entity Type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:BALOG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3233
Mailing Address - Country:US
Mailing Address - Phone:475-222-7136
Mailing Address - Fax:
Practice Address - Street 1:2139 SILAS DEANE HWY STE 207
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2339
Practice Address - Country:US
Practice Address - Phone:860-529-0828
Practice Address - Fax:860-398-5854
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor