Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7764 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 4447 | AZ |
NPI | 1245327394 |
---|---|
Provider Name | Dr. Samuel Larsen Hallows |
First Address | Mesa, AZ 85207-6400 |
Second Address | Mesa, AZ 85205-9049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 19/01/2020 |