Provider Demographics
NPI:1619412301
Name:THEM BONES CHIROPRACTIC
Entity Type:Organization
Organization Name:THEM BONES CHIROPRACTIC
Other - Org Name:PRENTISHA D. HAMILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:PRENTISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-356-9058
Mailing Address - Street 1:10405 N MACARTHUR BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7748
Mailing Address - Country:US
Mailing Address - Phone:901-356-9058
Mailing Address - Fax:
Practice Address - Street 1:10405 N MACARTHUR BLVD APT 315
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7748
Practice Address - Country:US
Practice Address - Phone:901-356-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty