Provider Demographics
NPI:1336187202
Name:HALL, CHARLES RONALD (RPH, DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RONALD
Last Name:HALL
Suffix:
Gender:M
Credentials:RPH, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0786
Mailing Address - Country:US
Mailing Address - Phone:256-232-5703
Mailing Address - Fax:
Practice Address - Street 1:613 E HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2150
Practice Address - Country:US
Practice Address - Phone:256-232-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT93009Medicare UPIN
AL000072288Medicare ID - Type Unspecified