Provider Demographics
NPI:1093918955
Name:HAMMOND CHIROPRACTIC LIFE CENTER, INC.
Entity Type:Organization
Organization Name:HAMMOND CHIROPRACTIC LIFE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAULTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:219-932-8900
Mailing Address - Street 1:5716 S HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2319
Mailing Address - Country:US
Mailing Address - Phone:219-932-8900
Mailing Address - Fax:219-932-8944
Practice Address - Street 1:5716 S HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2319
Practice Address - Country:US
Practice Address - Phone:219-932-8900
Practice Address - Fax:219-932-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000467A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCJ2555OtherRAILROAD MEDICARE