Healthcare Provider Details

I. General information

NPI: 1396775953
Provider Name (Legal Business Name): ROBERT ALAN BALLARD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 ROUTE 60 E SUITE 226
BARBOURSVILE WV
25504
US

IV. Provider business mailing address

6007 ROUTE 60 E SUITE 226
BARBOURSVILE WV
25504
US

V. Phone/Fax

Practice location:
  • Phone: 304-302-6060
  • Fax: 304-302-6062
Mailing address:
  • Phone: 304-302-6060
  • Fax: 304-302-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number194
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: