Provider Demographics
NPI:1396775953
Name:BALLARD, ROBERT ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 ROUTE 60 E
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BARBOURSVILE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-302-6060
Mailing Address - Fax:304-302-6062
Practice Address - Street 1:6007 ROUTE 60 E
Practice Address - Street 2:SUITE 226
Practice Address - City:BARBOURSVILE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-302-6060
Practice Address - Fax:304-302-6062
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000013183OtherBCBS
WV0131410000Medicaid
WV0415881Medicare ID - Type Unspecified
WV0131410000Medicaid