Provider Demographics
NPI:1275565285
Name:HALL, DAVID CHADWICK II (DC (CHIROPRACTOR))
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHADWICK
Last Name:HALL
Suffix:II
Gender:M
Credentials:DC (CHIROPRACTOR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-0175
Mailing Address - Country:US
Mailing Address - Phone:662-393-4848
Mailing Address - Fax:
Practice Address - Street 1:1134 CHURCH RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7144
Practice Address - Country:US
Practice Address - Phone:662-393-4848
Practice Address - Fax:662-393-4858
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1098111N00000X
TN1776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU84027Medicare UPIN
MS350000349Medicare ID - Type Unspecified