Broadway Plaza Pain Relief Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08001395A Issued in IN

Legal business name

BROADWAY PLAZA PAIN RELIEF CENTER

Practice address

801 W Glen Park Ave
Griffith, IN 46319-2087

Phone

(219) 924-2112

Fax

(219) 924-2114

NPI assigned

Aug 29, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert E Hall, D.C.

Title

Owner

Phone

(219) 924-2112

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hall Chiropractic Pain Relief Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409270400000",
    "number": "1184024937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W GLEN PARK AVE",
            "city": "GRIFFITH",
            "state": "IN",
            "postal_code": "463192087",
            "telephone_number": "219-924-2112",
            "fax_number": "219-924-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W GLEN PARK AVE",
            "city": "GRIFFITH",
            "state": "IN",
            "postal_code": "463192087",
            "telephone_number": "219-924-2112",
            "fax_number": "219-924-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY PLAZA PAIN RELIEF CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-29",
        "last_updated": "2014-08-29",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-924-2112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08001395A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100338150",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hall Chiropractic Pain Relief Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Beth Beverage, COTA
• Veronica M Boutros, RBT
• Susan M Bowen, MHSCCCSLP
• Valencia Boyd, RBT
• Nirmaldeep Singh Brar, DMD
• Tyrone Brown Jr., RBT
• Amie A Burns, APN
• Beth Callender, NP
• Dominique Carrington, RBT
• Destiny Carter

• Chiropractor in Griffith, IN
• Providers in Griffith, IN by specialty
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.