Provider Demographics
NPI:1073722849
Name:HALE, ELLIOTT MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:MARIE
Last Name:HALE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1210 20TH ST S
Mailing Address - Street 2:STE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3899
Mailing Address - Country:US
Mailing Address - Phone:470-385-0420
Mailing Address - Fax:
Practice Address - Street 1:1103 WOODFALL CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6819
Practice Address - Country:US
Practice Address - Phone:404-861-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR0006637111N00000X, 111NI0013X
GACHIR006637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner