Provider Demographics
NPI:1437161247
Name:FUNK HAMILTON, CAROL VIRGINIA (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:VIRGINIA
Last Name:FUNK HAMILTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:VIRGINIA
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1241 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1820
Mailing Address - Country:US
Mailing Address - Phone:661-758-3001
Mailing Address - Fax:661-758-4492
Practice Address - Street 1:1241 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1820
Practice Address - Country:US
Practice Address - Phone:661-758-3001
Practice Address - Fax:661-758-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17700111N00000X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0177000Medicare ID - Type UnspecifiedMEDICARE NUMBER