Provider Demographics
NPI:1982082277
Name:HALLAM, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:HALLAM
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:W1835 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-7936
Mailing Address - Country:US
Mailing Address - Phone:920-422-0050
Mailing Address - Fax:
Practice Address - Street 1:1541 BELLEVUE ST STE 5
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6266
Practice Address - Country:US
Practice Address - Phone:920-465-0101
Practice Address - Fax:920-468-1510
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5086-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor