Healthcare Provider Details

I. General information

NPI: 1104742121
Provider Name (Legal Business Name): NYUANA HALE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 S HOUSTON LAKE RD STE 3
WARNER ROBINS GA
31088-0724
US

IV. Provider business mailing address

1238 S HOUSTON LAKE RD STE 3
WARNER ROBINS GA
31088-0724
US

V. Phone/Fax

Practice location:
  • Phone: 478-202-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: