Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006980 | IA |
NPI | 1003019795 |
---|---|
Provider Name | Dr. Angela Tiana Ballew |
First Address | Davenport, IA 52803 |
Second Address | Davenport, IA 52803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 08/07/2007 |