Provider Demographics
NPI:1497774939
Name:HALL, BOBBIE ELAINE (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:BOBBIE
Middle Name:ELAINE
Last Name:HALL
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19069 VAN BUREN BLVD
Mailing Address - Street 2:#110
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9152
Mailing Address - Country:US
Mailing Address - Phone:951-789-7671
Mailing Address - Fax:951-789-7604
Practice Address - Street 1:19069 VAN BUREN BLVD
Practice Address - Street 2:#110
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9152
Practice Address - Country:US
Practice Address - Phone:951-789-7671
Practice Address - Fax:951-789-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26061111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician