Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | DC24138 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | DC24138 | CA |
NPI | 1063661130 |
---|---|
Provider Name | Dr. Anthony John Hall |
First Address | Malibu, CA 90265 |
Second Address | Malibu, CA 90265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |