Provider Demographics
NPI:1720172794
Name:HALLAWELL, JOHN B (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:HALLAWELL
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 1:3309 56TH ST NW
Mailing Address - Street 2:STE 109
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8572
Mailing Address - Country:US
Mailing Address - Phone:253-851-3311
Mailing Address - Fax:253-851-0382
Practice Address - Street 1:3309 56TH ST NW
Practice Address - Street 2:STE 109
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8572
Practice Address - Country:US
Practice Address - Phone:253-851-3311
Practice Address - Fax:253-851-0382
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34020111N00000X
OR283282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0153585OtherL & I
AB26367Medicare ID - Type Unspecified
A91946Medicare UPIN