Provider Demographics
NPI:1518393529
Name:DR KISHA HAMILTON LLC
Entity Type:Organization
Organization Name:DR KISHA HAMILTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEKISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-887-3700
Mailing Address - Street 1:2740 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2047
Mailing Address - Country:US
Mailing Address - Phone:417-887-3700
Mailing Address - Fax:
Practice Address - Street 1:2740 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2047
Practice Address - Country:US
Practice Address - Phone:417-887-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty