Healthcare Provider Details

I. General information

NPI: 1720194418
Provider Name (Legal Business Name): ANGELA HALL D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
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:
Title or Position:
Credential:
Phone: