Provider Demographics
NPI:1598596017
Name:HALL, DALTON (RD)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGH POINT WOODS DR APT 103
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3274
Mailing Address - Country:US
Mailing Address - Phone:256-714-6529
Mailing Address - Fax:256-714-6529
Practice Address - Street 1:25 HIGH POINT WOODS DR APT 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3274
Practice Address - Country:US
Practice Address - Phone:256-714-6529
Practice Address - Fax:256-714-6529
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5509-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered