Provider Demographics
NPI:1235480716
Name:LAKE HAMILTON FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LAKE HAMILTON FAMILY CHIROPRACTIC PLLC
Other - Org Name:LAKE HAMILTON FAMILY AND SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-762-9648
Mailing Address - Street 1:1880 AIRPORT RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-2117
Mailing Address - Country:US
Mailing Address - Phone:501-762-9648
Mailing Address - Fax:501-463-9196
Practice Address - Street 1:1880 AIRPORT RD STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-2117
Practice Address - Country:US
Practice Address - Phone:501-762-9648
Practice Address - Fax:501-463-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15999OtherSTATE LIC