Provider Demographics
NPI:1992758106
Name:BALLIF, JAMES B (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:BALLIF
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:PO BOX 324
Mailing Address - Street 2:408 N. MAIN
Mailing Address - City:CONCONULLY
Mailing Address - State:WA
Mailing Address - Zip Code:98819-0324
Mailing Address - Country:US
Mailing Address - Phone:509-826-5548
Mailing Address - Fax:509-826-5548
Practice Address - Street 1:408 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONCONULLY
Practice Address - State:WA
Practice Address - Zip Code:98819
Practice Address - Country:US
Practice Address - Phone:509-826-5548
Practice Address - Fax:509-826-5548
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8860068Medicare PIN
T76479Medicare UPIN