Provider Demographics
NPI:1023186046
Name:HALL, PAMELA DISQUE (MA, DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DISQUE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14981 GREENHORN RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8453
Mailing Address - Country:US
Mailing Address - Phone:530-477-1829
Mailing Address - Fax:530-477-1829
Practice Address - Street 1:14981 GREENHORN RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8453
Practice Address - Country:US
Practice Address - Phone:530-477-1829
Practice Address - Fax:530-477-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADT564ZMedicare PIN
CAU73832Medicare UPIN
CABI042Medicare PIN