Provider Demographics
NPI:1205930823
Name:HALL, MICHELLE LYNETTE (DC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNETTE
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 1:1704 WINKLER ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2251
Mailing Address - Country:US
Mailing Address - Phone:336-667-7246
Mailing Address - Fax:336-667-7296
Practice Address - Street 1:1704 WINKLER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2251
Practice Address - Country:US
Practice Address - Phone:336-667-7246
Practice Address - Fax:336-667-7296
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1994111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2102265OtherMAMSI
NC0849MOtherBLUE CROSS BLUE SHIELD
NC53292OtherMEDCOST
NC5779OtherPARTNERS
NC(89)0849MMedicaid
NC537642OtherAETNA PPO/POS
NC542746OtherFOCUS
NC2686558OtherAETNA HMO
NC53292OtherMEDCOST
NC(89)0849MMedicaid