Provider Demographics
NPI:1679587034
Name:BALLARD, SCOTT (DC DCTX6517)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DC DCTX6517
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 TEXAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611
Mailing Address - Country:US
Mailing Address - Phone:409-735-7356
Mailing Address - Fax:
Practice Address - Street 1:2158 TEXAS AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611
Practice Address - Country:US
Practice Address - Phone:409-735-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXDC6517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5095119OtherAETNA
TX605411OtherBCBS OF TX
TX5095119OtherAETNA