Derik Nelson Baltich, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3047 Issued in NC

Practice address

1086 River Hwy
Suite D
Mooresville, NC 28117-9147

Phone

(704) 799-1999

Fax

(704) 663-8225

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Sherman College of Straight Chiropractic, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Back 2 Back Chiropractic Group LLCGroup PAC ID 4789727413, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Back 2 Back Chiropractic Group LLC

  • Chiropractor
  • Mooresville, NC
  • NPI 1962560284
  Medicare reassignment Care Compare group NPD Authorized official
• Lake Norman Health and Wellness, PA

  • Chiropractor
  • Cornelius, NC
  • NPI 1417044637
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265241600000",
    "number": "1124198593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 JOE V KNOX AVENUE",
            "address_2": "SUITE C",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-799-1999",
            "fax_number": "704-663-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 RIVER HWY",
            "address_2": "SUITE D",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179147",
            "telephone_number": "704-799-1999",
            "fax_number": "704-663-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALTICH",
        "first_name": "DERIK",
        "middle_name": "NELSON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085MF",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Douglas Alan Balog, BS PHARMACY
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• Melissa Baralt, LCSW-A
• Barium Springs Home for Children
• Barium Springs Home for Children
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• Chiropractor in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.