=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881705366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN BRETT HALL D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14822 N HIGHWAY 41
-----------------------------------------------------
City | RATHDRUM
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83858-8461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-687-7029
-----------------------------------------------------
Fax | 208-687-9233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14822 N HIGHWAY 41
-----------------------------------------------------
City | RATHDRUM
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83858-8461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-687-7029
-----------------------------------------------------
Fax | 208-687-9233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIA924
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------