Healthcare Provider Details

I. General information

NPI: 1881705366
Provider Name (Legal Business Name): STEVEN BRETT HALL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14822 N HIGHWAY 41
RATHDRUM ID
83858-8461
US

IV. Provider business mailing address

14822 N HIGHWAY 41
RATHDRUM ID
83858-8461
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-7029
  • Fax: 208-687-9233
Mailing address:
  • Phone: 208-687-7029
  • Fax: 208-687-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA924
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: