Provider Demographics
NPI:1770655458
Name:BONES P.A.
Entity Type:Organization
Organization Name:BONES P.A.
Other - Org Name:BALLAS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-896-8080
Mailing Address - Street 1:9718 SAM FURR RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4929
Mailing Address - Country:US
Mailing Address - Phone:704-896-8080
Mailing Address - Fax:
Practice Address - Street 1:9718 SAM FURR RD UNIT D
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4929
Practice Address - Country:US
Practice Address - Phone:704-896-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0839ROtherBCBS PROVIDER NUMBER
NC890839RMedicaid
NC0839ROtherBCBS PROVIDER NUMBER
NCV94622Medicare UPIN