Provider Demographics
NPI:1346223435
Name:HAMILTON, TERRY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
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 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3415
Mailing Address - Country:US
Mailing Address - Phone:432-685-0777
Mailing Address - Fax:432-685-0778
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-685-0777
Practice Address - Fax:432-685-0778
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001601601Medicaid
TX603553Medicare ID - Type Unspecified
TX001601601Medicaid