Basic Information
| Provider Information | |||||||||
| NPI: | 1396015996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | ATC, MED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 SHERWOOD LAKE DRIVE | ||||||||
| Address2: | APT. 3A | ||||||||
| City: | SCHERERVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463752724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2195764599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1950 45TH AVE | ||||||||
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| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463213927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199228188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 36001167A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.