Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4991 | CO |
NPI | 1073552659 |
---|---|
Provider Name | Dr. Brandon D Hall |
First Address | Loveland, CO 80538-8310 |
Second Address | Loveland, CO 80538-8310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C522118 | MEDICARE PTAN (01) | CO |