Provider Demographics
NPI:1154994184
Name:HALL, GAVIN BRADLEY (BS, MS, DC)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:BRADLEY
Last Name:HALL
Suffix:
Gender:M
Credentials:BS, MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 W SUNSET BLVD STE 21-228
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4865
Mailing Address - Country:US
Mailing Address - Phone:435-429-2582
Mailing Address - Fax:
Practice Address - Street 1:42 S RIVER RD STE 8
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2139
Practice Address - Country:US
Practice Address - Phone:435-429-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12373584-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor