Provider Demographics
NPI:1073552659
Name:HALL, BRANDON D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:D
Last Name:HALL
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 1:3025 N TAFT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8310
Mailing Address - Country:US
Mailing Address - Phone:970-663-3600
Mailing Address - Fax:970-663-7674
Practice Address - Street 1:3025 N TAFT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8310
Practice Address - Country:US
Practice Address - Phone:970-663-3600
Practice Address - Fax:970-663-7674
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4991111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC522118OtherMEDICARE PTAN