Provider Demographics
NPI:1205872520
Name:HALL, BRUCE L (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
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 1:25078 PEACHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2551
Mailing Address - Country:US
Mailing Address - Phone:661-259-0202
Mailing Address - Fax:661-259-1870
Practice Address - Street 1:25078 PEACHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2533
Practice Address - Country:US
Practice Address - Phone:661-259-0202
Practice Address - Fax:661-259-1870
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15226Medicare ID - Type Unspecified
CAT18005Medicare UPIN