Provider Demographics
NPI:1578646485
Name:BALCH, DENNIS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAMES
Last Name:BALCH
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 1:431 LOMITA AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1117
Mailing Address - Country:US
Mailing Address - Phone:650-692-2273
Mailing Address - Fax:650-692-6237
Practice Address - Street 1:140 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-3121
Practice Address - Country:US
Practice Address - Phone:650-692-2273
Practice Address - Fax:650-692-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24791111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12638Medicare UPIN
DC0247910Medicare ID - Type Unspecified