Provider Demographics
NPI:1487728242
Name:BALBON, BRIAN W (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:BALBON
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 1:2460 MISSION ST
Mailing Address - Street 2:STE 218
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2467
Mailing Address - Country:US
Mailing Address - Phone:415-648-6054
Mailing Address - Fax:
Practice Address - Street 1:2460 MISSION ST.
Practice Address - Street 2:STE 218
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2415
Practice Address - Country:US
Practice Address - Phone:415-648-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0190300Medicare ID - Type Unspecified
CA5609727Medicare UPIN