Provider Demographics
NPI:1295880920
Name:HALL, CANDICE ALAINE (DC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:ALAINE
Last Name:HALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:MCCOWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4980 BARRANCA PKWY #200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-786-5050
Mailing Address - Fax:
Practice Address - Street 1:4980 BARRANCA PKWY #200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-786-5050
Practice Address - Fax:714-751-1053
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18999Medicare ID - Type Unspecified