Provider Demographics
NPI:1427135037
Name:BALL, JOHN TECUMSEH WALLACE (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TECUMSEH WALLACE
Last Name:BALL
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 1:70 N MCCLINTOCK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3711
Mailing Address - Country:US
Mailing Address - Phone:480-659-6020
Mailing Address - Fax:480-659-8544
Practice Address - Street 1:70 N MCCLINTOCK DR STE 6
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3711
Practice Address - Country:US
Practice Address - Phone:480-659-6020
Practice Address - Fax:480-659-8544
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7437111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV02608Medicare UPIN