Provider Demographics
NPI:1720246234
Name:JOSEPH R. HALL, DC
Entity Type:Organization
Organization Name:JOSEPH R. HALL, DC
Other - Org Name:FAMILY LIFE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROCKWELL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-598-0999
Mailing Address - Street 1:13599 SW PACIFIC HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4801
Mailing Address - Country:US
Mailing Address - Phone:503-598-0999
Mailing Address - Fax:503-598-7474
Practice Address - Street 1:13599 SW PACIFIC HWY
Practice Address - Street 2:SUITE E
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4801
Practice Address - Country:US
Practice Address - Phone:503-598-0999
Practice Address - Fax:503-598-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGHKBMedicare UPIN