Provider Demographics
NPI:1407855497
Name:BALLENGER, DAVID JON (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JON
Last Name:BALLENGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 DEERECO RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2120
Mailing Address - Country:US
Mailing Address - Phone:410-252-1000
Mailing Address - Fax:410-252-6809
Practice Address - Street 1:9632 DEERECO RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2120
Practice Address - Country:US
Practice Address - Phone:410-252-1000
Practice Address - Fax:410-252-6809
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD393M547FMedicare PIN