Healthcare Provider Details

I. General information

NPI: 1285721498
Provider Name (Legal Business Name): BALLENGER CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9632 DEERECO RD
TIMONIUM MD
21093-2120
US

IV. Provider business mailing address

9632 DEERECO RD
TIMONIUM MD
21093-2120
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-1000
  • Fax: 410-252-6809
Mailing address:
  • Phone: 410-252-1000
  • Fax: 410-252-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01982
License Number StateMD

VIII. Authorized Official

Name: DR. DAVID JON BALLENGER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 410-252-1000