MEDICARE: DR. JOHN FREDERICK BALLAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4339	NC

General Provider Information

NPI Number	:	1164761581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN FREDERICK BALLAM D.C.

Provider Business Mailing Address
First Line	:	201 DAVIS GROVE CIR STE 106
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-2513
Country	:	US
Telephone Number	:	919-363-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 DAVIS GROVE CIR
Second Line	:	SUITE 106
City	:	CARY
State	:	NC
Zip	:	27519-2512
Country	:	US
Telephone Number	:	515-509-1792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	02/20/2019

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