Healthcare Provider Details

I. General information

NPI: 1033716097
Provider Name (Legal Business Name): CHRISTOPHER BALLANTINE ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BUTLER AVE STE 104
FARMINGTON NM
87401-6867
US

IV. Provider business mailing address

3835 LA CRESTA DR
SAN DIEGO CA
92107-2719
US

V. Phone/Fax

Practice location:
  • Phone: 970-880-9380
  • Fax:
Mailing address:
  • Phone: 970-749-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: