Provider Demographics
NPI:1790439479
Name:HALL, TARA (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14314 MANECITA DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4034
Mailing Address - Country:US
Mailing Address - Phone:208-921-7124
Mailing Address - Fax:
Practice Address - Street 1:15375 BARRANCA PKWY
Practice Address - Street 2:#A104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:208-921-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor