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General NPI Number Information
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NPI Number | 1144526179
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Entity Type | Organization
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Legal Business Name | GARY W. HALL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 200 AUTO CENTER CT
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City | MODESTO
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State | CA
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Zip | 95356-1573
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Country | US
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Telephone | 209-527-5433
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Fax | 209-527-3128
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Provider Business Mailing Address
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Address Line | 200 AUTO CENTER CT
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City | MODESTO
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State | CA
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Zip | 95356-1573
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Country | US
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Telephone | 209-527-5433
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Fax | 209-527-3128
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Authorized Official
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Title or Position | OWNER
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Name | GARY W HALL
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Credential | D.C.
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Telephone | 209-527-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC11200
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License Number State | CA
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