Provider Demographics
NPI:1740298009
Name:BALZER, CARY (DC)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:
Last Name:BALZER
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 1:3948 3RD ST S # 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-303-8810
Mailing Address - Fax:
Practice Address - Street 1:125 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5387
Practice Address - Country:US
Practice Address - Phone:912-489-2888
Practice Address - Fax:912-489-2888
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00133795OtherRAILROAD MEDICARE
GAU69172Medicare UPIN
GA35ZCFCRMedicare ID - Type Unspecified