Provider Demographics
NPI:1013390939
Name:HAMMOND, TINA (DC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HAMMOND
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 1:639 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-1121
Mailing Address - Country:US
Mailing Address - Phone:503-843-3888
Mailing Address - Fax:503-843-4366
Practice Address - Street 1:639 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-1121
Practice Address - Country:US
Practice Address - Phone:503-843-3888
Practice Address - Fax:503-843-4366
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor