Provider Demographics
NPI:1174821417
Name:HALL, GARRETT D (DC)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
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 1:321 WESTGATE PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3071
Mailing Address - Country:US
Mailing Address - Phone:334-702-0898
Mailing Address - Fax:334-677-8409
Practice Address - Street 1:321 WESTGATE PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3071
Practice Address - Country:US
Practice Address - Phone:334-702-0898
Practice Address - Fax:334-677-8409
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor