Provider Demographics
NPI:1750418752
Name:HALL, THOMAS J III (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HALL
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 N TUSTIN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3612
Mailing Address - Country:US
Mailing Address - Phone:714-541-0500
Mailing Address - Fax:714-543-0990
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-541-0500
Practice Address - Fax:714-543-0990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330147144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00DC13921OtherBLUE CROSS BLUE SHIELD
CADC13921Medicare PIN