Provider Demographics
NPI:1861511354
Name:BALL CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:BALL CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:706-226-2332
Mailing Address - Street 1:1507 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-3697
Mailing Address - Country:US
Mailing Address - Phone:706-226-2332
Mailing Address - Fax:706-279-3161
Practice Address - Street 1:1507 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3697
Practice Address - Country:US
Practice Address - Phone:706-226-2332
Practice Address - Fax:706-279-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3363Medicare PIN