Provider Demographics
NPI:1568729887
Name:JAMI A. HAMILTON, DC, LLC
Entity Type:Organization
Organization Name:JAMI A. HAMILTON, DC, LLC
Other - Org Name:LAKE KIOWA FUNCTIONAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-668-8755
Mailing Address - Street 1:100 KIOWA DR W
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAKE KIOWA
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9584
Mailing Address - Country:US
Mailing Address - Phone:940-668-8755
Mailing Address - Fax:940-222-7642
Practice Address - Street 1:100 KIOWA DR W
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKE KIOWA
Practice Address - State:TX
Practice Address - Zip Code:76240-9584
Practice Address - Country:US
Practice Address - Phone:940-668-8755
Practice Address - Fax:940-222-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263573OtherMEDICARE PTAN