Provider Demographics
NPI:1962684894
Name:HALL, DANAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANAN
Middle Name:LEE
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 1:4815 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-9739
Mailing Address - Country:US
Mailing Address - Phone:502-477-5000
Mailing Address - Fax:502-477-5005
Practice Address - Street 1:4815 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-9739
Practice Address - Country:US
Practice Address - Phone:502-477-5000
Practice Address - Fax:502-477-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50019750Medicaid
KY00587001Medicare PIN