MEDICARE: DR. SCOTT BALLARD DC DCTX6517

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	TXDC6517	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5095119	OTHER	TX	AETNA
2	605411	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1679587034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT BALLARD DC DCTX6517

Provider Business Mailing Address
First Line	:	2158 TEXAS AVENUE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611
Country	:	US
Telephone Number	:	409-735-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 TEXAS AVENUE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611
Country	:	US
Telephone Number	:	409-735-7356
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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