| Organization Name: | BALLISTREA FAMILY CHIROPRACTIC LLC |
| NPI Number: | 1760780043 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN A BALLISTREA (OWNER) |
| Mailing Address: | 7236 State Road 52 Suite 3 Bayonet Point |
| State: | FL US |
| Postal Code: | 346676749 |
| Phone Number: | 7278684444 |
| Fax Number: | 7278682892 |
| NPI Enumeration Date: | 03/10/2011 |
| NPI Last Update Date: | 03/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111NI0013X |
| License Number: | CH8075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | Independent Medical Examiner |
| Taxonomy Definition: | A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues. |