Provider Demographics
NPI:1154792307
Name:HALSELL, ERIC MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:HALSELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 NW RENFRO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3471
Mailing Address - Country:US
Mailing Address - Phone:817-919-2171
Mailing Address - Fax:
Practice Address - Street 1:319 NW RENFRO ST
Practice Address - Street 2:SUITE A
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3471
Practice Address - Country:US
Practice Address - Phone:817-919-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor