Provider Demographics
NPI:1326292921
Name:HALL FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:HALL FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-846-8788
Mailing Address - Street 1:317 SOUTH BEACON BLVD.
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1948
Mailing Address - Country:US
Mailing Address - Phone:616-846-8788
Mailing Address - Fax:616-846-8796
Practice Address - Street 1:317 SOUTH BEACON BLVD.
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1948
Practice Address - Country:US
Practice Address - Phone:616-846-8788
Practice Address - Fax:616-846-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008495261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON55270OtherPTAN
ON55270OtherPTAN
MIU91974Medicare UPIN