MEDICARE: LOUIE T BALLIS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	768	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2918A	OTHER	LA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013020049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIE T BALLIS DC

Provider Business Mailing Address
First Line	:	2170 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3106
Country	:	US
Telephone Number	:	318-746-4445
Fax Number	:	318-746-0353

Provider Business Practice Location Address
First Line	:	2170 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111
Country	:	US
Telephone Number	:	318-746-4445
Fax Number	:	318-746-0353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/17/2009

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Directions to “ LOUIE T BALLIS DC” Practice Location

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