Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC1880 | TN |
NPI | 1508979337 |
---|---|
Provider Name | Dr. Ricky Hall |
First Address | Gray, TN 37615-6215 |
Second Address | Gray, TN 37615-6215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3972926 | (05) | TN |
U93783 | (02) | TN |