Provider Demographics
NPI:1013054022
Name:BALLMER, SCOTTI S (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTTI
Middle Name:S
Last Name:BALLMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SCOTTI
Other - Middle Name:
Other - Last Name:BALLMER-PITTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1624 N LEE TREVINO DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5100
Mailing Address - Country:US
Mailing Address - Phone:915-598-2225
Mailing Address - Fax:915-598-5203
Practice Address - Street 1:1624 N LEE TREVINO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5100
Practice Address - Country:US
Practice Address - Phone:915-598-2225
Practice Address - Fax:915-598-5203
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W8900OtherBLUE CROSS BLUE SHIELD OF