Provider Demographics
NPI:1952484677
Name:HALL, DENNIS LAVERNE SR (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LAVERNE
Last Name:HALL
Suffix:SR
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-0312
Mailing Address - Country:US
Mailing Address - Phone:704-782-0111
Mailing Address - Fax:704-788-1896
Practice Address - Street 1:217 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4763
Practice Address - Country:US
Practice Address - Phone:704-782-0111
Practice Address - Fax:704-788-1896
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908469Medicaid
NCT64148Medicare UPIN
NC244041AMedicare ID - Type Unspecified