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General NPI Number Information
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NPI Number | 1346968237
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Entity Type | Individual
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Provider Name | DANIEL JACOB HALL
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Gender | Male
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 2145 UNIVERSITY PARK DR STE 375
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City | OKEMOS
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State | MI
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Zip | 48864-6902
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Country | US
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Telephone | 517-312-6199
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 ROXBURGH AVE
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City | EAST LANSING
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State | MI
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Zip | 48823-1953
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Country | US
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Telephone | 517-763-5676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501012023
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License Number State | MI
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