Provider Demographics
NPI:1881915221
Name:HALL, CAROLYN A (DC)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:UNDERHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1521 MORENO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6836
Mailing Address - Country:US
Mailing Address - Phone:239-464-3558
Mailing Address - Fax:
Practice Address - Street 1:12731 WORLD PLAZA LN BLDG 83-1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4081
Practice Address - Country:US
Practice Address - Phone:239-970-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10027111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor