Provider Demographics
NPI:1811074206
Name:BALLANTYNE CHIROPRACTIC
Entity type:Organization
Organization Name:BALLANTYNE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUFUS
Authorized Official - Middle Name:B
Authorized Official - Last Name:OVERCASH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:704-540-4293
Mailing Address - Street 1:PO BOX 49343
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0077
Mailing Address - Country:US
Mailing Address - Phone:704-540-4293
Mailing Address - Fax:
Practice Address - Street 1:15105 L JOHN J DELANEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2847
Practice Address - Country:US
Practice Address - Phone:704-540-4293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2333586Medicare PIN