Provider Demographics
NPI:1013255488
Name:BALLARD, SHANNON ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:ELIZABETH
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8 DE ZAVALA PL
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1446
Mailing Address - Country:US
Mailing Address - Phone:210-521-6886
Mailing Address - Fax:
Practice Address - Street 1:7180 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1295
Practice Address - Country:US
Practice Address - Phone:210-521-6886
Practice Address - Fax:210-521-6608
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor