Provider Demographics
NPI:1841499803
Name:BALL CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BALL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-525-8611
Mailing Address - Street 1:10468 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2829
Mailing Address - Country:US
Mailing Address - Phone:510-525-8611
Mailing Address - Fax:510-525-2349
Practice Address - Street 1:10468 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2829
Practice Address - Country:US
Practice Address - Phone:510-525-8611
Practice Address - Fax:510-525-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 14620111N00000X
CADC 14546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ90520ZOtherBLUE SHIELD PROVIDER #