Provider Demographics
NPI:1952653685
Name:BALLANTYNE CHIROPRACTIC WELLNESS
Entity Type:Organization
Organization Name:BALLANTYNE CHIROPRACTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIPES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-369-5700
Mailing Address - Street 1:14825 BALLANTYNE VILLAGE WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4288
Mailing Address - Country:US
Mailing Address - Phone:704-369-5700
Mailing Address - Fax:
Practice Address - Street 1:14825 BALLANTYNE VILLAGE WAY STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4288
Practice Address - Country:US
Practice Address - Phone:704-369-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty