Provider Demographics
NPI:1053172056
Name:BALLARD, BLAIR MCKAY (DC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:MCKAY
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 N BLUFF ST STE A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4545
Mailing Address - Country:US
Mailing Address - Phone:435-674-2626
Mailing Address - Fax:
Practice Address - Street 1:237 N BLUFF ST STE A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4545
Practice Address - Country:US
Practice Address - Phone:435-674-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13752039-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician