Provider Demographics
NPI:1952516924
Name:BALESTRACCI, TERRESA DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRESA
Middle Name:DIANE
Last Name:BALESTRACCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3028
Mailing Address - Country:US
Mailing Address - Phone:908-231-8088
Mailing Address - Fax:908-722-8722
Practice Address - Street 1:154 ADAMSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3028
Practice Address - Country:US
Practice Address - Phone:908-231-8088
Practice Address - Fax:908-722-8722
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004708Medicare ID - Type Unspecified