Provider Demographics
NPI:1114465853
Name:HAMILTON HOLISTIC HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:HAMILTON HOLISTIC HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-337-5700
Mailing Address - Street 1:1518 CAMP JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2561
Mailing Address - Country:US
Mailing Address - Phone:618-337-5700
Mailing Address - Fax:618-337-7109
Practice Address - Street 1:1518 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2561
Practice Address - Country:US
Practice Address - Phone:618-337-5700
Practice Address - Fax:618-337-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty