Provider Demographics
NPI:1427565902
Name:HALVERSON, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4414
Mailing Address - Country:US
Mailing Address - Phone:718-402-5200
Mailing Address - Fax:718-402-5211
Practice Address - Street 1:14 BRUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4414
Practice Address - Country:US
Practice Address - Phone:718-402-5200
Practice Address - Fax:718-402-5211
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor