Provider Demographics
NPI:1942423314
Name:HALLAM, MICHELLE F (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:F
Last Name:HALLAM
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:PO BOX 550710
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96155-0012
Mailing Address - Country:US
Mailing Address - Phone:530-318-5444
Mailing Address - Fax:530-577-4757
Practice Address - Street 1:595 TAHOE KEYS BLVD
Practice Address - Street 2:SUITE A4
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3314
Practice Address - Country:US
Practice Address - Phone:530-318-5444
Practice Address - Fax:530-577-4757
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0163170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0163170Medicare UPIN