Provider Demographics
NPI:1316170962
Name:BALLARD, ABBIE JF (DC)
Entity type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:JF
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ABBIE
Other - Middle Name:J
Other - Last Name:FOX BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 6108
Mailing Address - Street 2:14225 E. RICKELMAN, SUITE D
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-6108
Mailing Address - Country:US
Mailing Address - Phone:217-347-5010
Mailing Address - Fax:217-347-5011
Practice Address - Street 1:14225 E 1600TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-6746
Practice Address - Country:US
Practice Address - Phone:217-347-5010
Practice Address - Fax:217-347-5011
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214866001Medicare PIN