Provider Demographics
NPI:1780178061
Name:HALL, CHRISTOPHER B (CPS-A)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:HALL
Suffix:
Gender:M
Credentials:CPS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 MAILE AVE # UP
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3315
Mailing Address - Country:US
Mailing Address - Phone:216-339-8366
Mailing Address - Fax:
Practice Address - Street 1:1428 MAILE AVE # UP
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3315
Practice Address - Country:US
Practice Address - Phone:216-339-8366
Practice Address - Fax:216-220-3204
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00100175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist