Healthcare Provider Details

I. General information

NPI: 1568903433
Provider Name (Legal Business Name): TIMOTHY S BALLITCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 W CAMPO BEILO DR STE B115
GLENDALE AZ
85308
US

IV. Provider business mailing address

7155 W CAMPO BEILO DR STE B115
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 480-740-9619
  • Fax: 623-322-3653
Mailing address:
  • Phone: 480-740-9619
  • Fax: 623-322-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8620
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAZ8620
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: