Healthcare Provider Details

I. General information

NPI: 1659439164
Provider Name (Legal Business Name): HALL FAMILY CHIROPRACTIC & WELLNESS CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MAIN ST
POYNETTE WI
53955-9329
US

IV. Provider business mailing address

PO BOX 398
POYNETTE WI
53955-0398
US

V. Phone/Fax

Practice location:
  • Phone: 608-635-8915
  • Fax: 608-635-8901
Mailing address:
  • Phone: 608-635-8915
  • Fax: 608-635-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4142-012
License Number StateWI

VIII. Authorized Official

Name: DR. ANGELA K HALL
Title or Position: OWNER
Credential: D.C.
Phone: 608-635-8915