Provider Demographics
NPI:1598154213
Name:BALLENGER, JOSHUA (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BALLENGER
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 1:23440 CIVIC CENTER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4855
Mailing Address - Country:US
Mailing Address - Phone:310-579-5949
Mailing Address - Fax:310-456-0778
Practice Address - Street 1:23440 CIVIC CENTER WAY STE 101
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4855
Practice Address - Country:US
Practice Address - Phone:310-579-5949
Practice Address - Fax:310-456-0778
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor