Provider Demographics
NPI:1699869057
Name:HALLER, CHRIS C (DC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:C
Last Name:HALLER
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 1:3940 PLANK RD.
Mailing Address - Street 2:SUITE J
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6869
Mailing Address - Country:US
Mailing Address - Phone:540-786-2002
Mailing Address - Fax:540-786-4402
Practice Address - Street 1:3940 PLANK RD.
Practice Address - Street 2:SUITE J
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6869
Practice Address - Country:US
Practice Address - Phone:540-786-2002
Practice Address - Fax:540-786-4402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA268811OtherALLIANCE PROVIDER NUMBER
VA075056OtherBLUE CROSS/BLUE SHIELD NO
VA2269761OtherAETNA PROVIDER NUMBER
VA61145OtherSOUTHERN HEALTH NO.
VAT21700Medicare UPIN