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General NPI Number Information
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NPI Number | 1477964294
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Entity Type | Individual
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Provider Name | JACOB HALL D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 600 S AIRPORT RD
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City | LONGMONT
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State | CO
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Zip | 80503-6424
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Country | US
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Telephone | 303-776-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 LAKE PARK WAY APT 306
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City | LONGMONT
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State | CO
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Zip | 80503-9289
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Country | US
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Telephone | 515-298-3327
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0007133
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License Number State | CO
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