Provider Demographics
NPI:1235467051
Name:HAMILTON, MICAH STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:STEPHEN
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23792 ROCKFIELD BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2868
Mailing Address - Country:US
Mailing Address - Phone:949-470-4757
Mailing Address - Fax:
Practice Address - Street 1:23792 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2868
Practice Address - Country:US
Practice Address - Phone:949-470-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor