Provider Demographics
NPI:1861429789
Name:HALL, MARTY JAY (DC)
Entity type:Individual
Prefix:DR
First Name:MARTY
Middle Name:JAY
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 1:1200 ARBORS CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5400
Mailing Address - Country:US
Mailing Address - Phone:817-477-1757
Mailing Address - Fax:
Practice Address - Street 1:1200 ARBORS CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5400
Practice Address - Country:US
Practice Address - Phone:817-360-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3099111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10032196Medicaid
TX10032196Medicaid
TX609196Medicare ID - Type Unspecified