Provider Demographics
NPI:1306029723
Name:ELLAH HEALTH SPECIALTIES, INC.
Entity Type:Organization
Organization Name:ELLAH HEALTH SPECIALTIES, INC.
Other - Org Name:DARON HALLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:HALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-583-8190
Mailing Address - Street 1:8877 W UNION HILLS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3008
Mailing Address - Country:US
Mailing Address - Phone:623-583-8190
Mailing Address - Fax:623-583-8788
Practice Address - Street 1:8877 W UNION HILLS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3008
Practice Address - Country:US
Practice Address - Phone:623-583-8190
Practice Address - Fax:623-583-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV00079Medicare UPIN
AZ81366Medicare PIN