Physician Compare National (NPI:1134542285)

HEALTHCARE PROVIDER: JONATHAN BALLARD D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1134542285
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941431647
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140321001606
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BALLARD
	Individual professional last name
Provider First Name	JONATHAN
	Individual professional first name
Provider Middle Name	DEWITT
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLEVELAND CHIROPRACTIC COLLEGE - KANSAS CITY
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	435 E 2ND AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	COMPLETE CARE CHIROPRACTIC
	Group Practice or individual's line 2 address
City	OWASSO
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	740553208
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y