Provider Demographics
NPI:1205215910
Name:HALL, TY (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:
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 1:4080 W BROADWAY AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:763-746-1244
Mailing Address - Fax:763-746-1246
Practice Address - Street 1:14050 PILOT KNOB RD STE 120
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6648
Practice Address - Country:US
Practice Address - Phone:952-423-5050
Practice Address - Fax:952-423-4560
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor