Individual
MS. PAMELA A BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
7N315 SYCAMORE AVE, MEDINAH, IL 60157-9799
(630) 307-7463
(630) 529-0087
Mailing address
PO BOX 460, MEDINAH, IL 60157-0460
(630) 529-0077
(630) 529-0087
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
038-006728
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232227
BLUECROSS BLUESHIELD
IL
05
—
038006728
—
IL
01
—
208982
MEDICARE GROUP NO.
IL
Enumeration date
04/14/2007
Last updated
08/10/2022
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