Provider Demographics
NPI:1487768065
Name:HALL, LOIS JANINE (DC)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:JANINE
Last Name:HALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13999 60TH ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2007
Mailing Address - Country:US
Mailing Address - Phone:651-430-1515
Mailing Address - Fax:651-430-1515
Practice Address - Street 1:13999 60TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-2007
Practice Address - Country:US
Practice Address - Phone:651-430-1515
Practice Address - Fax:651-430-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2349111N00000X
WI2214-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN959727100Medicaid
MN59716HAOtherBCBSMN IND PROVIDER NUMBE
MN59714HAOtherBCBSMN CLINIC NUMBER
MN59716HAOtherBCBSMN IND PROVIDER NUMBE
MN350001872Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE