Provider Demographics
NPI:1376768432
Name:HALL, THERON BRIGGS (DC)
Entity Type:Individual
Prefix:MR
First Name:THERON
Middle Name:BRIGGS
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 1:3630 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7153
Mailing Address - Country:US
Mailing Address - Phone:801-302-0301
Mailing Address - Fax:801-302-0311
Practice Address - Street 1:3630 WEST SOUTH JORDAN PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-302-0301
Practice Address - Fax:801-302-0311
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3552091202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
76597Medicare UPIN
UT0B006248Medicare ID - Type Unspecified