Provider Demographics
NPI:1396015996
Name:HALL, CHRIS DOUGLAS (ATC, MED)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:DOUGLAS
Last Name:HALL
Suffix:
Gender:M
Credentials:ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SHERWOOD LAKE DRIVE
Mailing Address - Street 2:APT. 3A
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2724
Mailing Address - Country:US
Mailing Address - Phone:219-576-4599
Mailing Address - Fax:
Practice Address - Street 1:1950 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3927
Practice Address - Country:US
Practice Address - Phone:219-922-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001167A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer