Provider Demographics
NPI:1558942862
Name:BALKCOM, CHRISTIAN (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BALKCOM
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 1:12160 S SHORE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6504
Mailing Address - Country:US
Mailing Address - Phone:561-249-0373
Mailing Address - Fax:
Practice Address - Street 1:12160 S SHORE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6504
Practice Address - Country:US
Practice Address - Phone:561-249-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor