Provider Demographics
NPI:1598948101
Name:BALBO, JESSICA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:BALBO
Suffix:
Gender:F
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:PO BOX 2052
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-2052
Mailing Address - Country:US
Mailing Address - Phone:970-626-7137
Mailing Address - Fax:970-626-4448
Practice Address - Street 1:112 VILLAGE SQ W UNIT 110
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-9241
Practice Address - Country:US
Practice Address - Phone:970-626-7137
Practice Address - Fax:970-626-4448
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor