Provider Demographics
NPI:1346735529
Name:HALL, MARY JUSTINE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JUSTINE
Last Name:HALL
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ALLEN RD UNIT 236
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-3806
Mailing Address - Country:US
Mailing Address - Phone:774-722-0632
Mailing Address - Fax:
Practice Address - Street 1:54 W TWIN OAKS TER STE 13
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7141
Practice Address - Country:US
Practice Address - Phone:802-391-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0134008171100000X
VT099.0134061175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist