Provider Demographics
NPI:1922212877
Name:HALL, TERRENCE MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:MATTHEW
Last Name:HALL
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 1:206 N STATE ST
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2536
Mailing Address - Country:US
Mailing Address - Phone:330-219-7312
Mailing Address - Fax:330-299-6055
Practice Address - Street 1:206 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2536
Practice Address - Country:US
Practice Address - Phone:330-219-7312
Practice Address - Fax:330-299-6055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0630900Medicaid
OH0630900Medicaid
OHT48260Medicare UPIN