Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007278 | IA |
N | 111NN1001X | Nutrition | 007278 | IA |
N | 111NS0005X | Chiropractic Sports Physician | 007278 | IA |
NPI | 1366766313 |
---|---|
Provider Name | Dr. Lucas Joe Ballenger |
First Address | West Des Moines, IA 50266-5816 |
Second Address | West Des Moines, IA 50266-5816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 09/04/2018 |