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General NPI Number Information
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NPI Number | 1760780043
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Entity Type | Organization
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Legal Business Name | BALLISTREA FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 7236 STATE ROAD 52 SUITE 3
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City | BAYONET POINT
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-868-4444
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Fax | 727-868-2892
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Provider Business Mailing Address
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Address Line | 7236 STATE ROAD 52 SUITE 3
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City | BAYONET POINT
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-868-4444
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Fax | 727-868-2892
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN A BALLISTREA
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Credential | D.C.
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Telephone | 727-868-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CH8075
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License Number State | FL
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