Provider Demographics
NPI:1912257361
Name:HALL, BRADLEY ALLEN I (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALLEN
Last Name:HALL
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRADLEY
Other - Middle Name:ALLEN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5765 BOZEMAN DR
Mailing Address - Street 2:APT 1325
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5601
Mailing Address - Country:US
Mailing Address - Phone:972-339-2464
Mailing Address - Fax:
Practice Address - Street 1:7010 PRESTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5869
Practice Address - Country:US
Practice Address - Phone:469-633-1155
Practice Address - Fax:469-633-1505
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12049111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12049OtherSTATE LICENSE