Provider Demographics
NPI:1033249594
Name:HALL, ANGELA R (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GRENDALL
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5046
Mailing Address - Country:US
Mailing Address - Phone:414-963-1411
Mailing Address - Fax:414-963-1430
Practice Address - Street 1:305 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GRENDALL
Practice Address - State:WI
Practice Address - Zip Code:53217-5046
Practice Address - Country:US
Practice Address - Phone:414-963-1411
Practice Address - Fax:414-963-1430
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T83401Medicare UPIN