Provider Demographics
NPI:1710617220
Name:HALL, MACKENZIE (DACM)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-2212
Mailing Address - Country:US
Mailing Address - Phone:617-240-1117
Mailing Address - Fax:
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 219
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1147
Practice Address - Country:US
Practice Address - Phone:415-968-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist