Healthcare Provider Details

I. General information

NPI: 1073552659
Provider Name (Legal Business Name): BRANDON D HALL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 N TAFT AVE SUITE C
LOVELAND CO
80538-8310
US

IV. Provider business mailing address

3025 N TAFT AVE SUITE C
LOVELAND CO
80538-8310
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3600
  • Fax: 970-663-7674
Mailing address:
  • Phone: 970-663-3600
  • Fax: 970-663-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4991
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: