MEDICARE: DR. JEFF GLENN HALL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	DC0000001789	TN

General Provider Information

NPI Number	:	1932140043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF GLENN HALL D.C.

Provider Business Mailing Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 103
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-614-7616
Fax Number	:	423-614-7668

Provider Business Practice Location Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 103
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-614-7616
Fax Number	:	423-614-7668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	11/20/2007

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