Provider Demographics
NPI:1801972393
Name:HALL, ROY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:LEE
Last Name:HALL
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 1:1715 FM 1626
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-280-6554
Mailing Address - Fax:512-282-8726
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-280-6554
Practice Address - Fax:512-282-8726
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX602038OtherBLUE CROSS BLUE SHIELD
TX602038OtherBLUE CROSS BLUE SHIELD