Provider Demographics
NPI:1679523104
Name:HALL, ROBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HALL
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 1:5360 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1555
Mailing Address - Country:US
Mailing Address - Phone:219-884-3250
Mailing Address - Fax:219-884-3828
Practice Address - Street 1:5360 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1555
Practice Address - Country:US
Practice Address - Phone:219-884-3250
Practice Address - Fax:219-884-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001395A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10338150Medicaid
IN405430Medicare ID - Type Unspecified
IN10338150Medicaid