Provider Demographics
NPI:1255630273
Name:HALE, MARY KRISTIN (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KRISTIN
Last Name:HALE
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 1:528 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-1060
Mailing Address - Country:US
Mailing Address - Phone:256-390-6490
Mailing Address - Fax:
Practice Address - Street 1:528 MAIN ST W
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:AL
Practice Address - Zip Code:35905-1060
Practice Address - Country:US
Practice Address - Phone:256-390-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008770111N00000X
AL2327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor