Provider Demographics
NPI:1053836148
Name:DR HALLAM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DR HALLAM CHIROPRACTIC LLC
Other - Org Name:CHIROPRACTIC HEALING AND ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-465-0101
Mailing Address - Street 1:1541 BELLEVUE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6266
Mailing Address - Country:US
Mailing Address - Phone:920-465-0101
Mailing Address - Fax:920-468-1510
Practice Address - Street 1:1541 BELLEVUE ST STE 5
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6266
Practice Address - Country:US
Practice Address - Phone:920-465-0101
Practice Address - Fax:920-468-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5086-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty