Provider Demographics
NPI:1245243419
Name:ANDERSON HAMO CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:ANDERSON HAMO CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERA
Authorized Official - Middle Name:HAMO
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-238-9066
Mailing Address - Street 1:1174 W HILL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4776
Mailing Address - Country:US
Mailing Address - Phone:810-238-9066
Mailing Address - Fax:810-238-9139
Practice Address - Street 1:1174 W HILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4776
Practice Address - Country:US
Practice Address - Phone:810-238-9066
Practice Address - Fax:810-238-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008899111N00000X, 111NS0005X
MI008894111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4775830Medicaid
MI4775821Medicaid
MI950B513500OtherBCBSM GROUP PIN
MI4775821Medicaid