Provider Demographics
NPI:1487839346
Name:HALLUM, CLIFFORD RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:RICHARD
Last Name:HALLUM
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 1:301 N RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3822
Mailing Address - Country:US
Mailing Address - Phone:714-525-8767
Mailing Address - Fax:714-525-8795
Practice Address - Street 1:301 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3822
Practice Address - Country:US
Practice Address - Phone:714-525-8767
Practice Address - Fax:714-525-8795
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT87324Medicare PIN