=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447794748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT INTEGRATIVE HEALTH AND HALL CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2016
-----------------------------------------------------
Last Update Date | 12/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4980 BARRANCA PKWY STE 200
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-786-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4980 BARRANCA PKWY STE 200
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-786-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CANDICE A. HALL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-786-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | DC22408
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------