Provider Demographics
NPI:1508979337
Name:HALL, RICKY
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:HALL
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 1:5205 BOBBY HICKS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6215
Mailing Address - Country:US
Mailing Address - Phone:423-477-9090
Mailing Address - Fax:423-477-0090
Practice Address - Street 1:5205 BOBBY HICKS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6215
Practice Address - Country:US
Practice Address - Phone:423-477-9090
Practice Address - Fax:423-477-0090
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1880111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972926Medicaid
TNU93783Medicare UPIN
TN3972917Medicare ID - Type UnspecifiedPROVIDER