1689955296 NPI number — DR. ROBERT D BALZA DC

Table of content: DR. ROBERT D BALZA DC (NPI 1689955296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689955296 NPI number — DR. ROBERT D BALZA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALZA
Provider First Name:
ROBERT
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689955296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-318-3007
Provider Business Mailing Address Fax Number:
210-468-0682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2135 DANA AVE STE 425
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45207-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-404-6050
Provider Business Practice Location Address Fax Number:
866-313-3397
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  DC-04211 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2301011124 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 249470 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 38MC00782000 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 04103 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CHIR010632 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: DC-04211 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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